Hirani Rahim, Okumura Kenji, Isath Ameesh, Gregory Vasiliki, Khan Shazli, Dhand Abhay, Lanier Gregg M, Spielvogel David, Kai Masashi, Ohira Suguru
New York Medical College, Valhalla, New York, USA.
Division of Cardiothoracic Surgery, Department of Surgery, Westchester Medical Center, Valhalla, New York, USA.
Clin Transplant. 2023 Dec;37(12):e15124. doi: 10.1111/ctr.15124. Epub 2023 Sep 8.
The advent of direct-acting antivirals has helped to increase the safe utilization of organs from hepatitis C virus positive (HCV+) donors. However, the outcomes of heart transplantation (HT) using an HCV+ donor are unclear in recipients with underlying liver disease represented by an elevated model for end-stage liver disease excluding international normalized ratio (MELD-XI).
The United Network of Organ Sharing database was queried from Jan 2016 to Dec 2021. Post-transplant outcomes stratified by recipient MELD-XI score (low <10.37, medium, 10.38-13.39, and high >13.4) was compared between patients with HT from HCV+ (N = 792) and patients with HT from HCV-negative donors (N = 15,266).
The median MELD-XI score was comparable (HCV+, 12.1, vs. HCV-negative, 11.8, p = .37). In the HCV+ group, donors were older (33 vs. 31 years, p < .001). Ischemic time of donor hearts (3.48 vs. 3.28 h, p < .001) and travel distance (250 vs. 157 miles, p < .001) were longer in HCV+ group. In the Kaplan Meier analysis with a median follow-up of 750 days, survival was comparable between the two groups (2-year survival, MELD-XI Low: HCV+, 92.4 ± 3.6% vs. HCV-negative, 91.1 ±.8%, p = .83, Medium: HCV+ 89.2 ± 4.3% vs. HCV-negative, 88.2 ± 1.0%, p = .68, and High: HCV+, 84.9 ± 4.5% vs. HCV-negative, 84.6 ± 1.1%, p = .75) In multivariate Cox hazard models, HCV donors were not associated with mortality in each MELD-XI subgroup (Low: adjusted hazard ratio (aHR), 1.02, p = .94; Medium: aHR, .95, p = .81; and High: aHR, .93, p = .68).
Utilization of HCV+ hearts was not associated with an increased risk of adverse outcomes in recipients with an elevated MELD- XI score.
直接作用抗病毒药物的出现有助于提高丙型肝炎病毒阳性（HCV+）供体器官的安全利用率。然而，在以终末期肝病模型（不包括国际标准化比值，即MELD-XI）升高为特征的潜在肝病受者中，使用HCV+供体进行心脏移植（HT）的结果尚不清楚。
查询器官共享联合网络数据库2016年1月至2021年12月的数据。比较HCV+供体心脏移植患者（N = 792）和HCV阴性供体心脏移植患者（N = 15266）按受者MELD-XI评分分层（低<10.37、中，10.38 - 13.39、高>13.4）的移植后结局。
MELD-XI评分中位数相当（HCV+组为12.1，HCV阴性组为11.8，p = 0.37）。在HCV+组中，供体年龄更大（33岁对31岁，p < 0.001）。HCV+组供体心脏的缺血时间更长（3.48小时对3.28小时，p < 0.001），转运距离更远（250英里对157英里，p < 0.001）。在中位随访750天的Kaplan Meier分析中，两组生存率相当（2年生存率，MELD-XI低：HCV+组为92.4 ± 3.6%，HCV阴性组为91.1 ± 0.8%，p = 0.83；中：HCV+组为89.2 ± 4.3%，HCV阴性组为88.2 ± 1.0%，p = 0.68；高：HCV+组为84.9 ± 4.5%，HCV阴性组为84.6 ± 1.1%，p = 0.75）。在多变量Cox风险模型中，HCV供体与各MELD-XI亚组的死亡率无关（低：调整后风险比（aHR）为1.02，p = 0.94；中：aHR为0.95，p = 0.81；高：aHR为0.93，p = 0.68）。
对于MELD-XI评分升高的受者，使用HCV+供体心脏与不良结局风险增加无关。
