Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Ann Thorac Surg. 2021 Aug;112(2):511-518. doi: 10.1016/j.athoracsur.2020.08.044. Epub 2020 Oct 26.
In the era of direct-acting antiviral therapies, hepatitis C-positive organs offer a strategy to expand the donor pool. Heart failure patients with concomitant renal insufficiency benefit from combined heart/kidney transplant. In 2017, we began utilizing organs from hepatitis C donors for heart/kidney transplants.
Characteristics and outcomes of heart/kidney transplants were collected at our institution from 2012 through 2019. We determined patient cohorts by donor hepatitis C antibody status, antibody positive (HCV+) vs antibody negative (HCV-). Outcomes of interest include survival, postoperative allograft function, and waitlist time. Summary and descriptive statistics, as well as survival analyses, were performed.
Thirty-nine patients underwent heart/kidney transplantation from 2012-2019. Twelve patients received HCV+ organs, and 27 patients received HCV- organs with minimal differences in donor and recipient cohort characteristics. Recipients who consented to receive HCV+ organs had a shorter median waitlist time. HCV+ and HCV- groups had similar perioperative and early postoperative cardiac function and similar rates of delayed renal graft function. HCV+ recipients demonstrated higher creatinine levels at 3 months posttransplant compared with HCV- recipients, but by 1-year post-transplant, creatinine levels in both groups were similar. The groups had similar 30-day and 1-year survival.
This study is a single-center series of heart/kidney transplant using HCV+ donors. When the potential increased risk of early postoperative renal dysfunction is balanced against similar survival and decreased waitlist time, the results suggest that HCV+ donors are an important source of transplantable organs for heart/kidney transplantation.
在直接作用抗病毒治疗时代，丙型肝炎阳性器官为扩大供体池提供了一种策略。合并肾功能不全的心力衰竭患者受益于心脏/肾脏联合移植。2017 年，我们开始使用丙型肝炎供体器官进行心脏/肾脏移植。
本研究在我院收集了 2012 年至 2019 年期间心脏/肾脏移植的特征和结果。我们根据供体丙型肝炎抗体状态确定了患者队列，即抗体阳性（HCV+）与抗体阴性（HCV-）。感兴趣的结果包括存活率、术后移植物功能和等待名单时间。进行了汇总和描述性统计以及生存分析。
2012 年至 2019 年期间，39 例患者接受了心脏/肾脏移植。12 例患者接受了 HCV+器官，27 例患者接受了 HCV-器官，供体和受体队列特征几乎没有差异。同意接受 HCV+器官的患者等待名单时间更短。HCV+和 HCV-组在围手术期和术后早期心脏功能方面相似，并且延迟的肾移植物功能的发生率也相似。与 HCV-受体相比，HCV+受体在移植后 3 个月时肌酐水平更高，但在移植后 1 年时，两组的肌酐水平相似。两组的 30 天和 1 年生存率相似。
本研究是一项使用 HCV+供体的心脏/肾脏联合移植的单中心研究。当平衡潜在的术后早期肾功能障碍增加的风险与相似的存活率和缩短的等待名单时间时，结果表明 HCV+供体是心脏/肾脏移植的重要移植器官来源。
