Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Division of Nephrology and Hypertension, Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota, USA.
Transpl Infect Dis. 2024 Feb;26(1):e14213. doi: 10.1111/tid.14213. Epub 2023 Dec 19.
Utilization of hepatitis C viremic (HCV+) deceased donor kidneys (DDKT) for aviremic recipients increases opportunities for transplantation with excellent short-term outcomes. Our primary aim was to understand longer-term outcomes, specifically assessing kidney and liver function in the first year posttransplant.
This was a retrospective single-center study of adult DDKT recipients of HCV+ kidneys (cases) matched 1:1 to recipients of HCV- kidneys (comparators). Between-group outcomes were analyzed using comparisons of means and proportions, survival analysis methods, and multivariable mixed effects models.
Sixty-five cases and 65 comparators had statistically comparable demographic and clinical characteristics. There were no between-group differences in serum creatinine or estimated glomerular filtration rate at month 12 (p = .662) or in their trajectories over months 1-12 (p > .292). Within the first 60 days, rates of liver function values >3 times upper limit of normal among cases were comparable to comparators for aspartate aminotransferase (AST) (14% vs. 6%, p = .242) and higher for alanine transaminase (ALT) (23% vs. 6%, p = .011). AST declined during the first 8 weeks (p = .005) and stabilized for both groups (p = .406) during the following 10 months. ALT declined during the first 8 weeks (p < .001), continued to decline over months 3-12 (p = .016), and the trajectory was unrelated to antiviral therapy initiation among cases.
Aviremic recipients of HCV+ kidneys had comparable kidney outcomes to matched recipients of HCV- kidneys. Despite more HCV+ recipients having an elevation in ALT within the first 60 days, ALT values normalized with no identified liver complications attributed to HCV.
利用丙型肝炎病毒血症（HCV+）已故供体肾脏（DDKT）为无病毒血症受者进行移植可增加移植机会，并带来出色的短期效果。我们的主要目的是了解更长期的结果，特别是在移植后第一年评估肾脏和肝功能。
这是一项回顾性单中心研究，纳入了接受 HCV+ 供肾的成年 DDKT 受者（病例组），并按 1:1 与接受 HCV-供肾的受者（对照组）相匹配。使用均值和比例比较、生存分析方法和多变量混合效应模型对组间结果进行分析。
65 例病例组和 65 例对照组在统计学上具有可比的人口统计学和临床特征。在第 12 个月时，两组间的血清肌酐或估算肾小球滤过率无差异（p =.662），且在 1-12 个月的轨迹上也无差异（p >.292）。在最初的 60 天内，病例组的肝功能值超过正常值上限 3 倍的发生率与对照组相比，天门冬氨酸氨基转移酶（AST）相似（14%比 6%，p =.242），而丙氨酸氨基转移酶（ALT）更高（23%比 6%，p =.011）。AST 在最初的 8 周内下降（p =.005），并且在随后的 10 个月中两组均稳定（p =.406）。ALT 在最初的 8 周内下降（p <.001），并在 3-12 个月期间持续下降（p =.016），并且该轨迹与病例组抗病毒治疗的启动无关。
无病毒血症的 HCV+ 供肾受者的肾脏结局与匹配的 HCV-供肾受者相当。尽管在最初的 60 天内，更多的 HCV+ 受者的 ALT 升高，但 ALT 值恢复正常，未发现与 HCV 相关的肝脏并发症。
