Division of Internal Medicine, Department of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus OH, USA.
Division of Surgery, Department of Transplantation, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Ann Hepatol. 2021 Sep-Oct;24:100318. doi: 10.1016/j.aohep.2021.100318. Epub 2021 Jan 27.
The success of direct-acting antivirals (DAA) has transformed the management of hepatitis C virus (HCV) infection and has led to the expansion of the deceased donor organ pool for liver transplantation.
We present a single center retrospective review of liver transplantations performed on HCV-seronegative recipients from HCV-seropositive organs from 11/2017 to 05/2020. HCV nucleic acid testing (NAT) was performed on HCV-seropositive donors to assess active HCV infection.
42 HCV-seronegative recipients underwent a liver transplant from a HCV-seropositive donor, including 21 NAT negative (20 liver, 1 simultaneous liver kidney transplant) and 21 NAT positive liver transplants. Two (9.5%) HCV antibody positive/NAT negative recipients developed HCV viremia and achieved sustained virologic response with DAA therapy. The remaining patients with available data (19 patients) remained polymerase chain reaction (PCR) negative at 6 months. 20 (95%) of HCV antibody positive/NAT positive recipients had a confirmed HCV viremia. 100% of patients with available data (15 patients) achieved SVR. Observed events include 1 mortality and graft loss and equivalent rates of post-transplant complications between NAT positive and NAT negative recipients.
HCV-seropositive organs can be safely transplanted into HCV-seronegative patients with minimal complications post-transplant.
直接作用抗病毒药物（DAA）的成功应用改变了丙型肝炎病毒（HCV）感染的治疗方式，并扩大了肝移植的供体器官池。
我们回顾性分析了 2017 年 11 月至 2020 年 5 月期间，HCV 血清阳性供体向 HCV 血清阴性受体进行的肝移植。对 HCV 血清阳性供体进行 HCV 核酸检测（NAT）以评估其是否存在活动性 HCV 感染。
42 例 HCV 血清阴性受体接受了 HCV 血清阳性供体的肝移植，其中 21 例 NAT 阴性（20 例为单纯肝移植，1 例为肝肾联合移植），21 例 NAT 阳性肝移植。2 例（9.5%） HCV 抗体阳性/NAT 阴性受体发生 HCV 病毒血症，经 DAA 治疗后实现持续病毒学应答。其余有可用数据的患者（19 例）在 6 个月时 PCR 仍为阴性。20 例（95%） HCV 抗体阳性/NAT 阳性受体确认存在 HCV 病毒血症。所有有可用数据的患者（15 例）均获得 SVR。观察到的事件包括 1 例死亡和移植物丢失，NAT 阳性和 NAT 阴性受体的移植后并发症发生率相当。
HCV 血清阳性的供体器官可以安全地移植给 HCV 血清阴性的患者，移植后并发症较少。
