From the Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China.
Exp Clin Transplant. 2022 Dec;20(12):1076-1084. doi: 10.6002/ect.2022.0315.
Kidneys from hepatitis C virus-positive donors were often discarded due to the lack of an effective treatment for hepatitis C virus. However, the advent of direct-acting antivirals has facilitated great progress for treatment of hepatitis C virus, providing additional opportunities for patients waiting for kidney transplant. We explored the feasibility and safety of kidney transplant from hepatitis C virus- positive donors to hepatitis C virus-negative recipients in combination with direct-acting antiviral therapy.
This was a single-center retrospective study of 7 recipients of hepatitis C virus- positive kidneys from June 2018 to June 2021. All recipients were treated with sofosbuvir/velpatasvir for 12 weeks after kidney transplant. The primary recipients' outcome was achievement of sustained viral eradication at 12 weeks after treatment, and follow-up secondary outcomes were kidney function recovery, liver function, and adverse drug reactions. We reviewed previous studies, from 2017 to 2022, to analyze achievement of sustained viral eradication at 12 weeks after treatment, recipient and graft survival, and adverse event of kidney transplant from a hepatitis C virus-positive donor to a hepatitis C virus-negative recipient.
Median follow-up time was 71 weeks (range, 56-183 weeks). All recipients achieved sustained viral eradication at 12 weeks after treatment, and their kidney function recovered without severe liver damage or adverse drug reactions. Previous studies suggested that transplant of hepatitis C virus-positive donor kidneys is safe and feasible when combined with direct-acting antiviral therapy. However, details regarding optimal duration of treatment and directacting antiviral regimen remain undetermined, so prospective randomized studies are warranted.
Our study further confirms that kidney transplant from hepatitis C virus-positive donors to hepatitis C virus-negative recipients is safe and feasible with direct-acting antiviral treatment. Grafts from hepatitis C virus-infected donors may be effective to resolve the problem of kidney shortage.
由于缺乏有效的丙型肝炎病毒治疗方法，丙型肝炎病毒阳性供体的肾脏通常被丢弃。然而，直接作用抗病毒药物的出现为丙型肝炎病毒的治疗带来了巨大的进展，为等待肾移植的患者提供了更多的机会。我们探讨了丙型肝炎病毒阳性供体肾脏移植到丙型肝炎病毒阴性受者体内，并结合直接作用抗病毒治疗的可行性和安全性。
这是一项单中心回顾性研究，纳入了 2018 年 6 月至 2021 年 6 月期间接受丙型肝炎病毒阳性供体肾脏移植的 7 例受者。所有受者在肾移植后均接受索磷布韦/维帕他韦治疗 12 周。主要受者的转归为治疗后 12 周时达到持续病毒学应答，随访的次要转归为肾功能恢复、肝功能和药物不良反应。我们回顾了 2017 年至 2022 年期间的既往研究，以分析治疗后 12 周时达到持续病毒学应答、受者和移植物存活率以及丙型肝炎病毒阳性供体肾脏移植到丙型肝炎病毒阴性受者后的不良事件的发生率。
中位随访时间为 71 周（范围，56-183 周）。所有受者在治疗后 12 周时均达到持续病毒学应答，且肾功能恢复，无严重肝损伤或药物不良反应。既往研究表明，结合直接作用抗病毒治疗，丙型肝炎病毒阳性供体肾脏移植是安全可行的。然而，关于最佳治疗持续时间和直接作用抗病毒方案的细节仍不确定，因此需要前瞻性随机研究。
本研究进一步证实，丙型肝炎病毒阳性供体肾脏移植到丙型肝炎病毒阴性受者体内，并结合直接作用抗病毒治疗是安全可行的。来自丙型肝炎病毒感染供体的移植物可能有效解决肾脏短缺问题。
