Kothadia Jiten P, Bhalla Anshul, Molnar Miklos Z, Mohan Rahul, Balaraman Vasanthi, Talwar Manish, Helmick Ryan, Eymard Corey, Clark Ian, Jain Richa, Faust Thomas W, Vanatta Jason M, Eason James D, Nair Satheesh P
James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN.
Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN.
Transplant Direct. 2022 May 26;8(6):e1342. doi: 10.1097/TXD.0000000000001342. eCollection 2022 Jun.
Long-term liver outcome in hepatitis C virus (HCV)-negative kidney recipients who acquired HCV infection from viremic donors is of intense interest in the transplant community. We evaluated the incidence of fibrosis in liver biopsy specimens of recipients who were transplanted with HCV-infected grafts.
Patients were evaluated in the hepatology clinic, and 29 patients agreed to undergo liver biopsy. The liver histology was scored by the meta-analysis of histological data in viral hepatitis scoring system and was assessed by hepatopathologists. The fibrosis score was compared between patients who initiated direct-acting antiviral (DAA) within 6 wk (n = 6) and after 6 wk (n = 29).
Eighty-nine aviremic patients were transplanted with HCV-infected grafts between March 2018 and October 2019. All patients developed HCV infection and were treated with DAA treatment after kidney transplantation (median, 70 d; interquartile range, 55-85 d). All patients (n = 89) achieved sustained virologic response with DAA. The median follow-up time from kidney transplant to liver biopsy was 28 mo (interquartile range, 26-30 mo). Twenty-five patients (86%) had F0, and 4 patients (14%) had F1 fibrosis. No patient had advanced fibrosis (F3-F4). Grade 1 inflammation was present in 6 (21%) patients, whereas 26 (90%) patients had iron accumulation in the hepatocytes and reticuloendothelial cells. There was no difference in the fibrosis score between patients who received treatment within 6 wk versus after 6 wk ( = 0.55).
Kidney transplantation of HCV-infected graft to HCV-negative recipients is safe and has no long-term liver-related complications with successful eradication of HCV. In our cohort, delayed treatment did not affect sustained virologic response or liver histology.
从病毒血症供体获得丙型肝炎病毒（HCV）感染的HCV阴性肾移植受者的长期肝脏转归是移植界极为关注的问题。我们评估了接受HCV感染移植物移植的受者肝活检标本中的纤维化发生率。
在肝病门诊对患者进行评估，29例患者同意接受肝活检。肝组织学采用病毒性肝炎评分系统中的组织学数据进行荟萃分析评分，并由肝病病理学家进行评估。比较在6周内开始直接抗病毒药物（DAA）治疗的患者（n = 6）和6周后开始治疗的患者（n = 29）之间的纤维化评分。
2018年3月至2019年10月期间，89例非病毒血症患者接受了HCV感染移植物移植。所有患者均发生HCV感染，并在肾移植后接受DAA治疗（中位数为70天；四分位间距为55 - 85天）。所有患者（n = 89）使用DAA均实现了持续病毒学应答。从肾移植到肝活检的中位随访时间为28个月（四分位间距为26 - 30个月）。25例患者（占86%）为F0，4例患者（占14%）为F1纤维化。无患者出现晚期纤维化（F3 - F4）。6例（占21%）患者存在1级炎症，而26例（占90%）患者的肝细胞和网状内皮细胞中有铁沉积。6周内接受治疗的患者与6周后接受治疗的患者之间的纤维化评分无差异（P = 0.55）。
将HCV感染的移植物移植给HCV阴性受者进行肾移植是安全的，成功根除HCV后无长期肝脏相关并发症。在我们的队列中，延迟治疗不影响持续病毒学应答或肝脏组织学。
