丙型肝炎阳性供体肺移植：中期结果令人安心。
Lung Transplantation from hepatitis C+ donor lungs: Reassuring midterm outcomes.
机构信息
David Geffen School of Medicine, University of California, Los Angeles, California; Department of Surgery, Division of Cardiac Surgery, University of California, Los Angeles, California.
Division of Cardiothoracic Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin.
出版信息
J Heart Lung Transplant. 2024 Feb;43(2):337-345. doi: 10.1016/j.healun.2023.10.014. Epub 2023 Oct 20.
BACKGROUND
The development of modern antiviral therapy for hepatitis C virus (HCV) has allowed for the transplantation of HCV nucleic acid amplification testing-positive (NAT+) donor lungs with acceptable short-term outcomes. We sought to evaluate trends and midterm outcomes of lung transplant recipients of HCV NAT+ donor allografts.
METHODS
All adults undergoing isolated lung transplantation in the United Network for Organ Sharing database from January 2016 to December 2022 were included in the study. Lung transplant recipients were stratified based on donor HCV status (HCV NAT+ vs NAT-). Propensity score matching was used to adjust for differences between groups. Several outcomes, including acute rejection by 1 year, early (30-day and in-hospital) mortality, and both 1- and 3-year survival, were compared between matched groups.
RESULTS
A total of 16,725 patients underwent lung transplantation during the study period, with 489 (3%) receiving HCV NAT+ donor lungs. Regions 1 (18%) and 6/8 (both 0%) had the highest and lowest proportions, respectively, of HCV NAT+ donor transplants. Utilization of HCV NAT+ donors increased throughout the study period from 2 (0.1%) in 2016 to a peak of 117 (5%) in 2019. Donors who were HCV NAT+ were younger (34 vs 36 years, p < 0.001), more often female (44% vs 39%, p < 0.01), and more commonly died due to drug intoxication (56% vs 15%, p < 0.001). Recipients of HCV NAT+ donor lungs were similar in age (62 vs 62 years, p = 0.69) and female gender (43% vs 39%, p = 0.15) but had lower lung allocation scores (38 vs 41, p < 0.001) compared to others. Rates of acute rejection (13% vs 17%, p = 0.09), early mortality (30-day: 2% vs 1%, p = 0.59, in-hospital: 3% vs 4%, p = 0.38), as well as 1-year (90% vs 92%, p = 0.29) and 3-year survival (69% vs 75%, p = 0.13) were not significantly different between matched groups.
CONCLUSIONS
Lung transplant recipients of HCV NAT+ donor allografts experience similar rates of acute rejection, early mortality, and 3-year survival compared to all other lung recipients. Increased use of HCV NAT+ donor allografts may help to expand the donor pool and alleviate donor shortages.
背景
丙型肝炎病毒（HCV）的现代抗病毒治疗的发展使得可以接受 HCV 核酸扩增检测阳性（NAT+）供体肺进行移植，且短期结果可以接受。我们旨在评估 HCV NAT+供体同种异体肺移植受者的趋势和中期结果。
方法
本研究纳入了 2016 年 1 月至 2022 年 12 月期间在美国器官共享网络数据库中接受单纯肺移植的所有成年人。根据供者 HCV 状态（NAT+与 NAT-）对肺移植受者进行分层。采用倾向评分匹配来调整组间差异。比较匹配组之间急性排斥反应（1 年）、早期（30 天和住院期间）死亡率以及 1 年和 3 年生存率等多个结果。
结果
在研究期间，共有 16725 例患者接受了肺移植，其中 489 例（3%）接受了 HCV NAT+供体肺。区域 1（18%）和区域 6/8（均为 0%）的 HCV NAT+供体移植比例最高和最低。整个研究期间，HCV NAT+供体的使用率从 2016 年的 2 例（0.1%）增加到 2019 年的 117 例（5%）的峰值。HCV NAT+供体更年轻（34 岁 vs 36 岁，p<0.001），更常见为女性（44% vs 39%，p<0.01），且更常见因药物中毒而死亡（56% vs 15%，p<0.001）。HCV NAT+供体肺移植受者在年龄（62 岁 vs 62 岁，p=0.69）和女性性别（43% vs 39%，p=0.15）方面相似，但肺分配评分较低（38 分 vs 41 分，p<0.001）。急性排斥反应发生率（13% vs 17%，p=0.09）、早期死亡率（30 天：2% vs 1%，p=0.59，住院期间：3% vs 4%，p=0.38）以及 1 年生存率（90% vs 92%，p=0.29）和 3 年生存率（69% vs 75%，p=0.13）在匹配组之间无显著差异。
结论
与其他所有肺移植受者相比，HCV NAT+供体肺移植受者的急性排斥反应、早期死亡率和 3 年生存率相似。增加 HCV NAT+供体同种异体肺的使用可能有助于扩大供体库并缓解供体短缺。
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