Department of Urology, Chinese PLA General Hospital, Beijing, China.
Transplant Center, Massachusetts General Hospital, Boston, MA, USA.
Transpl Int. 2021 Dec;34(12):2562-2569. doi: 10.1111/tri.14152. Epub 2021 Nov 11.
Direct-acting antivirals (DAA) transformed hepatitis C virus (HCV) treatment in 2014; however, their impact on transplant candidates' willingness to accept (CWTA) organs from HCV donors remains uncertain. We retrospectively studied Organ Procurement and Transplantation Network data from 2008 to 2019, investigating CWTA different organs from HCV donors over time, using segmented multivariable logistic regression, and how that influenced wait-time and deceased-donor transplantation (DDTx) probability, using multivariable logistic or linear regression. We found that DAA availability was associated with a marked increase in CWTA in all organs from HCV donors except intestine. By December 2020, 40% of kidney, 33% of kidney-pancreas, 42% of pancreas, over 50% of liver, heart, lung, heart-lung, and 9% of intestine candidates waitlisted were CWTA an organ from HCV donors. Compared with pre-DAA, yearly CWTA kidney from HCV donors increased post-DAA 1.81 -fold, kidney-pancreas . 2.78 -fold, pancreas 3.69 -fold, liver 1.54 -fold, heart . 2.0 . -fold, and lung 2.1 . -fold. CWTA kidney and liver from HCV donors significantly increased DDTx probability post-DAA ( 2.04 -fold and 1.29 -fold, respectively) and shortened kidney candidates' wait-time 90 days (Mean with 95% CI). CWTA organs from HCV donors rose significantly with DAA availability, benefitting kidney and liver candidates with increased DDTx rates and shortened kidney candidates' wait time. Further long-term outcomes investigation and standardized organ from HCV donors' education could improve both provider and patient acceptance and utilization.
直接作用抗病毒药物（DAA）在 2014 年改变了丙型肝炎病毒（HCV）的治疗方法；然而，它们对移植候选人接受（CWTA）来自 HCV 供体器官的意愿的影响仍不确定。我们回顾性地研究了 2008 年至 2019 年的器官获取和移植网络数据，调查了随着时间的推移来自 HCV 供体的不同器官的 CWTA，使用分段多变量逻辑回归，以及这如何影响等待时间和已故供体移植（DDTx）的概率，使用多变量逻辑或线性回归。我们发现，DAA 的可用性与除肠道外来自 HCV 供体的所有器官的 CWTA 显著增加有关。到 2020 年 12 月，40%的肾脏、33%的肾胰、42%的胰腺、超过 50%的肝脏、心脏、肺脏、心肺和 9%的肠道候选人在等待名单上是 CWTA 来自 HCV 供体的器官。与 DAA 前相比，DAA 后 CWTA 肾脏来自 HCV 供体的年增长率增加了 1.81 倍，肾胰增加了 2.78 倍，胰腺增加了 3.69 倍，肝脏增加了 1.54 倍，心脏增加了 2.00 倍，肺脏增加了 2.10 倍。CWTA 肾脏和肝脏来自 HCV 供体在 DAA 后显著增加了 DDTx 的概率（分别增加了 2.04 倍和 1.29 倍），并缩短了肾脏候选人的等待时间 90 天（Mean with 95% CI）。随着 DAA 可用性的提高，来自 HCV 供体的 CWTA 器官显著增加，使肾脏和肝脏候选人的 DDTx 率提高，肾脏候选人的等待时间缩短。进一步的长期结果调查和对 HCV 供体器官的标准化教育可以提高提供者和患者的接受度和利用率。
