Dilwali Natasha, Hartley Christopher, Sue Paul K, Karnsakul Wikrom
Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Johns Hopkins University of Medicine, Baltimore, MD 21287, USA.
Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Pathogens. 2024 Oct 30;13(11):947. doi: 10.3390/pathogens13110947.
The use of hepatitis C virus (HCV)-positive donors in organ transplantation has become increasingly viable due to advancements in direct-acting antiviral (DAA) therapies, which offer high cure rates. This review aims to evaluate the current practices, benefits, and challenges of utilizing HCV-positive donors for organ transplantation. The recent data show that transplant centers are progressively accepting HCV-positive donors for various organs, including kidneys, livers, and hearts, given the efficacy of post-transplant antiviral treatment. Using these donors has helped mitigate the organ shortage crisis, increasing the donor pool and reducing waitlist times. Despite these advantages, the approach raises concerns about viral transmission, long-term outcomes, and the cost-effectiveness of post-transplant DAA therapy. Furthermore, this review highlights the ethical implications of informed consent and the monitoring of HCV-negative recipients following transplantation. The outcomes from recent studies suggest that with proper management, transplantations from HCV-positive donors to HCV-negative recipients can be safe and effective, leading to excellent graft function and patient survival. This review synthesizes existing research and offers insights into optimizing protocols for future transplants involving HCV-positive donors.
由于直接抗病毒药物(DAA)疗法取得进展,治愈率高,在器官移植中使用丙型肝炎病毒(HCV)阳性供体已变得越来越可行。本综述旨在评估利用HCV阳性供体进行器官移植的当前做法、益处和挑战。最近的数据表明,鉴于移植后抗病毒治疗的有效性,移植中心越来越多地接受HCV阳性供体用于各种器官,包括肾脏、肝脏和心脏。使用这些供体有助于缓解器官短缺危机,增加供体库并缩短等待名单时间。尽管有这些优势,但这种方法引发了对病毒传播、长期结果以及移植后DAA治疗的成本效益的担忧。此外,本综述强调了知情同意的伦理意义以及移植后对HCV阴性受者的监测。最近研究的结果表明,通过适当管理,从HCV阳性供体到HCV阴性受者的移植可以是安全有效的,从而实现出色的移植物功能和患者存活。本综述综合了现有研究,并为优化未来涉及HCV阳性供体的移植方案提供见解。