Steinbrink Julie M, Byrns Jennifer, Berg Carl, Kappus Matthew, King Lindsay, Ellis Matthew J, Sanoff Scott, Agarwal Richa, DeVore Adam D, Reynolds John M, Hartwig Matthew G, Milano Carmelo, Sudan Debra, Maziarz Eileen K, Saullo Jennifer, Alexander Barbara D, Wolfe Cameron R
Division of Infectious Diseases, Duke University School of Medicine, Durham, NC.
Department of Pharmacy, Duke University Hospital, Durham, NC.
Transplant Direct. 2023 Oct 10;9(11):e1539. doi: 10.1097/TXD.0000000000001539. eCollection 2023 Nov.
Hepatitis C virus (HCV) nucleic acid amplification test (NAAT)-positive donors have increased the organ pool. Direct-acting antivirals (DAAs) have led to high rates of treatment success and sustained virologic response (SVR) in recipients with donor-derived HCV infection without significant adverse effects, although variability remains in the timing and duration of antivirals.
This retrospective study analyzed all adult HCV-NAAT-negative transplant recipients who received an organ from HCV-NAAT-positive donors from November 24, 2018, to March 31, 2022, at Duke University Medical Center with protocolized delay of DAA initiation until after hospital discharge, with at least 180-d follow-up on all patients. Transplant and HCV-related outcomes were analyzed.
Two hundred eleven transplants (111 kidneys, 41 livers, 34 hearts, and 25 lungs) were performed from HCV-NAAT-positive donors to HCV-NAAT-negative recipients. Ninety percent of recipients became viremic within 7 d posttransplant. Ninety-nine percent of recipients were initiated on pangenotypic DAAs in the outpatient setting a median of 52 d posttransplant, most commonly with 12-wk courses of sofosbuvir-velpatasvir (lungs) and glecaprevir-pibrentasvir (heart, kidney, and liver). Ninety-seven percent of recipients had SVR after a first-line DAA; all ultimately achieved SVR at 12 wk after subsequent treatment courses. The median peak HCV RNA for all organ systems was 2 436 512 IU/mL; the median time from antiviral to undetectable RNA was 48 d, although differences were noted between organ groups. No patient deaths or graft losses were directly attributable to HCV infection.
One hundred percent of transplant recipients of HCV-NAAT-positive organs ultimately developed SVR without significant adverse effects when HCV antivirals were initiated in the outpatient setting after transplant hospitalization, suggesting that this real-world treatment pathway is a viable option.
丙型肝炎病毒（HCV）核酸扩增检测（NAAT）呈阳性的供体增加了器官库。直接作用抗病毒药物（DAA）已使供体来源的HCV感染受者获得了较高的治疗成功率和持续病毒学应答（SVR），且无明显不良反应，尽管抗病毒药物的使用时机和疗程仍存在差异。
这项回顾性研究分析了2018年11月24日至2022年3月31日期间在杜克大学医学中心接受来自HCV-NAAT阳性供体器官的所有成年HCV-NAAT阴性移植受者，按照方案将DAA起始治疗推迟至出院后，并对所有患者进行至少180天的随访。分析了移植及与HCV相关的结局。
共进行了211例移植手术（111例肾移植、41例肝移植、34例心脏移植和25例肺移植），供体HCV-NAAT阳性，受体HCV-NAAT阴性。90%的受者在移植后7天内出现病毒血症。99%的受者在门诊开始使用泛基因型DAA，移植后中位时间为52天，最常用的是12周疗程的索磷布韦-维帕他韦（肺移植）和格卡瑞韦-哌仑他韦（心脏、肾脏和肝移植）。97%的受者在一线DAA治疗后获得SVR；所有受者在后续治疗疗程后的12周均最终实现SVR。所有器官系统的HCV RNA峰值中位数为2436512 IU/mL；从开始抗病毒治疗到RNA检测不到的中位时间为48天，尽管不同器官组之间存在差异。没有患者死亡或移植物丢失直接归因于HCV感染。
当在移植住院后门诊开始使用HCV抗病毒药物时，100%的HCV-NAAT阳性器官移植受者最终都获得了SVR，且无明显不良反应，这表明这种实际应用的治疗途径是一种可行的选择。
