Vanterpool Karen B, Diallo Kadiatou, Kim Ellie, Van Pilsum Rasmussen Sarah E, Johnson Morgan A, Predmore Zachary, Brundage Janetta, Barnaba Brittany, Desai Niraj, Levan Macey L, Sung Hannah C, Kates Olivia, Sugarman Jeremy, Durand Christine M
Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Open Forum Infect Dis. 2024 Jan 10;11(3):ofae015. doi: 10.1093/ofid/ofae015. eCollection 2024 Mar.
Organ transplantation from donors with hepatitis C viremia (HCV) to recipients without HCV (HCV D+/R-) has excellent medical outcomes. Less is known about the psychosocial impact and experiences of HCV D+/R- recipients, particularly outside of clinical trials.
We conducted in-depth, semistructured interviews with 24 HCV D+/R- recipients (kidney, n = 8; lung, n = 7; liver, n = 5; heart, n = 3; simultaneous heart and kidney, n = 1) who received transplants outside of clinical trials and were treated for HCV after transplant to assess their experiences and perspectives. We used thematic analysis to analyze the interviews.
Interviewees' reasons for accepting an HCV D + organ were based on perceived benefits and confidence in the effectiveness of HCV treatment. The majority (62%) received HCV treatment within 1 month after transplant (range, 1 day-2 months). Most interviewees reported positive transplant outcomes, including reduced wait times and improved survival, health, physical activity, and quality of life. Overall, themes and experiences did not differ significantly between different organ transplant types. Generally, interviewees did not perceive stigma from those aware of the HCV D+ transplant; yet, disclosure was selective and a few recipients reported concerns from family members about posttransplant HCV transmission risk. Other common concerns included treatment costs and delays, which were not always anticipated by recipients.
Our findings suggest that HCV D+/R- kidney, liver, and heart and lung transplant recipients outside of clinical trials had overall positive experiences. However, HCV transmission risk, treatments costs, and treatment delays were a source of concern that might be mitigated with targeted pretransplant education.
将丙型肝炎病毒血症（HCV）供体的器官移植给无HCV的受体（HCV D+/R-）可带来出色的医学疗效。对于HCV D+/R-受体的心理社会影响和经历，人们了解较少，尤其是在临床试验之外。
我们对24名HCV D+/R-受体（肾移植8例；肺移植7例；肝移植5例；心脏移植3例；心肺联合移植1例）进行了深入的半结构式访谈，这些受体在临床试验之外接受了移植，并在移植后接受了HCV治疗，以评估他们的经历和观点。我们采用主题分析法对访谈进行分析。
受访者接受HCV D+器官的原因基于感知到的益处以及对HCV治疗有效性的信心。大多数（62%）在移植后1个月内（范围为1天至2个月）接受了HCV治疗。大多数受访者报告了积极的移植结果，包括等待时间缩短、生存率提高、健康状况改善、身体活动能力增强以及生活质量提高。总体而言，不同器官移植类型之间的主题和经历没有显著差异。一般来说，受访者并未感受到知晓HCV D+移植情况的人带来的耻辱感；然而，信息披露是有选择性的，少数受体报告称家庭成员担心移植后HCV传播风险。其他常见担忧包括治疗费用和延误，而受体并不总是能预料到这些情况。
我们的研究结果表明，临床试验之外的HCV D+/R-肾、肝、心脏和肺移植受体总体上有积极的经历。然而，HCV传播风险、治疗费用和治疗延误是令人担忧的问题，通过有针对性的移植前教育可能会有所缓解。
