Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Curr Opin Infect Dis. 2022 Aug 1;35(4):321-329. doi: 10.1097/QCO.0000000000000840. Epub 2022 Jul 5.
Passage of the HOPE Act and the advent of direct-acting antiviral (DAA) therapies have allowed for expansion of the donor organ pool to include donors with human immunodeficiency virus (HIV) and hepatitis C virus (HCV), thus providing new opportunities for waitlist candidates. This article provides updates on recent studies in solid organ transplantation (SOT) utilizing donors with HIV and HCV.
The first pilot studies of kidney and liver transplantation from donors-with-HIV to recipients-with-HIV (HIV D+/R+) show robust patient survival, comparable graft survival to transplantation from donors without HIV (HIV D-/R+) and no increased rates of HIV breakthrough. The number of HIV D+ organs utilized has been lower than initial estimates due to several potential factors. With high numbers of overdose deaths from the opioid epidemic, there have been more HCV D+ organs available, leading to transplantation in recipients without HCV (HCV D+/R-) in combination with DAAs. Outcomes in both abdominal and thoracic HCV D+/R transplantation are excellent.
With recent findings of good outcomes in both HIV D+/R+ and HCV D+/R- SOT, we feel the evidence supports both practices as standard clinical care options to mitigate organ shortage and reduce waitlist mortality.
目的：《希望法案》的通过和直接作用抗病毒（DAA）治疗方法的出现，使包括艾滋病毒（HIV）和丙型肝炎病毒（HCV）感染者在内的供体器官库得到扩展，从而为等候名单上的候选人提供了新的机会。本文介绍了利用 HIV 和 HCV 供体进行实体器官移植（SOT）的最新研究进展。
最新发现：首例 HIV 感染者向 HIV 感染者（HIV D+/R+）进行肾和肝移植的试点研究显示，患者存活率高，移植效果与无 HIV 感染者（HIV D-/R+）相当，且无 HIV 突破性感染发生率增加。由于多种潜在因素，实际利用的 HIV 阳性供体器官数量低于最初估计。由于阿片类药物流行导致过量死亡人数增加，HCV 阳性供体器官数量增加，导致 HCV D+/R- 受者接受 HCV D+/R- 肝移植，同时联合 DAA 治疗。腹部和胸部 HCV D+/R 移植的结果都非常好。
总结：最近在 HIV D+/R+和 HCV D+/R- SOT 中都有良好结果的发现，我们认为这一证据支持这两种做法作为标准的临床治疗选择，以减轻器官短缺和降低等候名单死亡率。
