Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
Division of General Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, NY.
Transplantation. 2022 Sep 1;106(9):1787-1798. doi: 10.1097/TP.0000000000004116. Epub 2022 Apr 6.
Liver transplantation (LT) from hepatitis C virus (HCV)-positive donors [antibody positive (Ab+) or nucleic acid test-positive (NAT+) donors] has been reported to achieve successful outcomes. However, donor and recipient selection has not been well-characterized.
Data between 2015 and 2019 were obtained from the United Network for Organ Sharing database. The utilization rates and graft survival among 35 239 potential donors and 23 780 adult LT recipients were reviewed based on donor HCV Ab/NAT status.
The utilization of Ab+/NAT+ donors was significantly reduced compared with HCV-negative donors (66.4% versus 80.0%, P < 0.001) among donors aged between 40 and 69 y. Recipients of livers from HCV-positive donors had lower laboratory and allocation Model for End-stage Liver Disease scores (both P < 0.001). HCV-positive donors were younger ( P < 0.001). Kaplan-Meyer survival curves demonstrated significantly superior 1-y graft survival in recipients of HCV-positive grafts compared with those from HCV-negative grafts ( P = 0.004; 97.1% in Ab-/NAT+, 93.9% in Ab+/NAT-, and 93.7% in Ab+/NAT+ versus 91.8% in Ab-/NAT-). Multivariate analysis for 1-y graft survival identified donor age [hazard ratio (HR) = 1.01; 95% confidence interval (CI), 1.00-1.01] and laboratory Model for End-stage Liver Disease score (HR = 1.01; 95% CI, 1.00-1.01) as independent predictors but not donor HCV status: HR 0.77' 95% CI, 0.58-1.02 in Ab+/NAT-; HR 0.82' 95% CI, 0.66-1.03 in Ab+/NAT+; and HR 0.39' 95% CI, 0.10-1.55 in Ab-/NAT+.
More widespread utilization of HCV-positive donors, especially Ab+/NAT+ donors of age 40-69 y, may expand the donor pool without impairing short-term outcomes after LT.
从丙型肝炎病毒（HCV）阳性供体（抗体阳性[Ab+]或核酸检测阳性[NAT+]供体）进行肝移植（LT）已被报道可获得成功的结果。然而，供体和受者的选择尚未得到很好的描述。
我们从 2015 年至 2019 年期间从美国器官共享网络数据库中获取数据。根据供体 HCV Ab/NAT 状态，回顾了 35239 名潜在供体和 23780 名成人 LT 受者中供体利用率和移植物存活率。
在 40 至 69 岁的供体中，Ab+/NAT+供体的利用率明显低于 HCV 阴性供体（66.4%比 80.0%，P<0.001）。HCV 阳性供体的实验室和分配终末期肝病模型评分均较低（均 P<0.001）。HCV 阳性供体更年轻（P<0.001）。Kaplan-Meier 生存曲线显示，HCV 阳性移植物受者的 1 年移植物存活率明显优于 HCV 阴性移植物受者（P=0.004；Ab-/NAT+为 97.1%，Ab+/NAT-为 93.9%，Ab+/NAT+为 93.7%，Ab-/NAT-为 91.8%）。1 年移植物存活率的多变量分析确定了供体年龄[风险比（HR）=1.01；95%置信区间（CI），1.00-1.01]和实验室终末期肝病模型评分（HR=1.01；95%CI，1.00-1.01）是独立的预测因素，但不是供体 HCV 状态：Ab+/NAT-的 HR 为 0.77（95%CI，0.58-1.02）；Ab+/NAT+的 HR 为 0.82（95%CI，0.66-1.03）；Ab-/NAT+的 HR 为 0.39（95%CI，0.10-1.55）。
更广泛地利用 HCV 阳性供体，特别是年龄在 40-69 岁的 Ab+/NAT+供体，可能会扩大供体库，而不会损害 LT 后的短期结果。
