Gillis Barbara, Villanueva Daphne, Marsh Wallis, Afridi Faryal, Danforth Jessie, Thornberg Megan, Chaudhary Vishy, Sharma Rajeev
From the Department of Transplant Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA.
Exp Clin Transplant. 2024 Mar;22(3):185-188. doi: 10.6002/ect.2024.0034.
Before the advent of direct-acting antiviral therapy for hepatitis C virus, a large proportion of kidneys from donors with hepatitis C viremia were discarded. Hepatitis C virus is now amenable to effective treatment with excellent seronegativity rates. In this study, we review the outcomes of hepatitis C viremic kidneys transplanted into hepatitis C-naive recipients.
In this retrospective observational study, we examined 6 deceased donor kidneys with hepatitis C viremia that were transplanted into hepatitis C-naive recipients between March 2020 and April 2021 at a single center. Because of health insurance constraints, patients were treated for hepatitis C virus with glecaprevir/pibrentasvir for 8 weeks following seroconversion posttransplant. Primary outcome measured was viral seroconversion; secondary outcomes included graft function, posttransplant complications, and all-cause mortality.
On average, patients seroconverted 6 days (range, 4-10 d) after transplant and began treatment 26 days (range, 15-37 d) after seroconversion. An 8-week course of antiviral treatment was successful in preventing acute hepatitis C virus infection in all patients. Posttransplant median creatinine was 1.96 mg/dL (range, 1-4.55 mg/dL), whereas median estimated glomerular filtration rate was 41.33 mL/min/1.73 m2 (range, 17-85 mL/min/1.73 m2). Patient survival rate was 66.7%, and death-censored graft survival rate was 100%. Two patients died from unrelated reasons: 1 from acute respiratory failure secondary to SARS-CoV-2 infection and 1 from posttransplant lymphoproliferative disorder. Two patients developed allograft rejection posttransplant (1 developed antibody mediated rejection, 1 developed borderline T-cell-mediated cellular rejection). Other major complications included neutropenia, fungal rash, SARS-CoV-2 infection, cytomegalovirus, BK virus, and Epstein-Barr virus reactivation.
Use of hepatitis C-viremic donor kidneys for transplant is a safe option and has great potential to increase the kidney donor pool, as long as high index of suspicion is maintained for allograft rejection and opportunistic infections.
在丙型肝炎病毒直接抗病毒治疗出现之前，很大一部分来自丙型肝炎病毒血症供体的肾脏被丢弃。丙型肝炎病毒现在可以通过有效的治疗获得极佳的血清学转阴率。在本研究中，我们回顾了将丙型肝炎病毒血症肾脏移植给未感染丙型肝炎受体的结果。
在这项回顾性观察研究中，我们检查了2020年3月至2021年4月期间在单一中心移植给未感染丙型肝炎受体的6个来自已故供体的丙型肝炎病毒血症肾脏。由于医疗保险限制，患者在移植后血清转化后用格卡瑞韦/哌仑他韦治疗丙型肝炎病毒8周。测量的主要结局是病毒血清转化；次要结局包括移植肾功能、移植后并发症和全因死亡率。
平均而言，患者在移植后6天（范围4 - 10天）血清转化，并在血清转化后26天（范围15 - 37天）开始治疗。8周的抗病毒治疗疗程成功地预防了所有患者的急性丙型肝炎病毒感染。移植后肌酐中位数为1.96mg/dL（范围1 - 4.55mg/dL），而估计肾小球滤过率中位数为41.33mL/min/1.73m²（范围17 - 85mL/min/1.73m²）。患者生存率为66.7%，死亡截尾移植肾生存率为100%。两名患者死于无关原因：1例死于继发于SARS-CoV-2感染的急性呼吸衰竭，1例死于移植后淋巴细胞增殖性疾病。两名患者移植后发生移植肾排斥反应（1例发生抗体介导的排斥反应，1例发生临界性T细胞介导的细胞排斥反应）。其他主要并发症包括中性粒细胞减少、真菌疹、SARS-CoV-2感染、巨细胞病毒、BK病毒和EB病毒再激活。
使用丙型肝炎病毒血症供体肾脏进行移植是一种安全的选择，并且有很大潜力增加肾脏供体库，只要对移植肾排斥反应和机会性感染保持高度怀疑指数。
