Division of Pediatric Infectious Diseases, Department of Pediatrics, Stanford University School of Medicine, California, USA.
Department of Pharmacy, Lucile Packard Children's Hospital at Stanford, California, USA.
Pediatr Transplant. 2024 Nov;28(7):e14879. doi: 10.1111/petr.14879.
Although adult transplant centers are successfully transplanting organs from hepatitis C virus (HCV)-infected donors with detectable viral load by nucleic acid testing (NAT+) into HCV-negative recipients, this practice has not yet been adopted widely by the pediatric heart transplant community.
We present a case series of four patients who received heart transplants from HCV NAT+ donors at a pediatric transplant center, including two pediatric patients < 18 years of age.
All recipients tolerated a 12-week course of glecaprevir/pibrentasvir and achieved a sustained virologic response with no HCV or liver complications with over 1 year of follow-up (range 1.4-2.5 years). All four have had good post-heart transplant outcomes with normal graft function and good functional status without rejection or cardiac allograft vasculopathy at time of last follow-up.
This case series details the successful multidisciplinary implementation of a protocol to accept cardiac allografts from HCV NAT+ donors for transplantation into HCV negative recipients at our pediatric transplant center. With the limited donor pool in pediatrics and the morbidity associated with prolonged durations on the transplant waitlist, pediatric centers should consider utilizing organs from HCV NAT+ donors to broaden the donor pool. Future work should evaluate other organs beyond heart and optimal timing and duration of direct acting antiviral therapy.
尽管成人移植中心通过核酸检测（NAT+）成功地将具有可检测病毒载量的丙型肝炎病毒（HCV）感染供体的器官移植到 HCV 阴性受者体内，但这种做法尚未被儿科心脏移植界广泛采用。
我们报告了在一家儿科移植中心，4 例 HCV NAT+供体心脏移植受者的病例系列，其中包括 2 例<18 岁的儿科患者。
所有受者均耐受了 12 周的 glecaprevir/pibrentasvir 治疗，在超过 1 年的随访中（范围 1.4-2.5 年）实现了持续病毒学应答，无 HCV 或肝脏并发症。在最后一次随访时，所有 4 例患者均具有良好的心脏移植后结局，移植物功能正常，功能状态良好，无排斥反应或心脏移植物血管病。
本病例系列详细介绍了在我们的儿科移植中心，成功实施了一项多学科方案，接受 HCV NAT+供体的心脏移植物，移植到 HCV 阴性受者体内。在儿科中，供体有限，在移植等待名单上长时间等待会带来发病率，因此儿科中心应考虑利用 HCV NAT+供体的器官来扩大供体库。未来的研究应评估心脏以外的其他器官，以及直接作用抗病毒治疗的最佳时机和持续时间。
