Nakayama Toshihiro, Krist David T, Akabane Miho, Imaoka Yuki, Esquivel Carlos O, Kwong Allison J, Kwo Paul Y, Melcher Marc L, Sasaki Kazunari
Division of Abdominal Transplant, Department of Surgery, Stanford University, Stanford, California, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, California, USA.
Liver Transpl. 2025 Sep 1;31(9):1154-1164. doi: 10.1097/LVT.0000000000000557. Epub 2024 Dec 17.
Long-term outcomes of using HCV-positive donors in HCV-negative recipients in liver transplantation (LT) are not well established. Data from the United Network for Organ Sharing (UNOS) database between July 1, 2015, and December 31, 2023, were analyzed. The cohort included 44,447 HCV antibody-negative (Ab-) candidates who underwent deceased donor LT. Changes in case numbers and utilization rates of HCV-positive donors, divided into HCV-viremic (NAT+) or Ab+ nonviremic (Ab+/NAT-), were assessed. Kaplan-Meier analysis and propensity score matching were used to evaluate 5-year graft survival. The number of HCV-viremic donation after brain death (DBD) donors and their use in LT for HCV Ab- recipients peaked at 640 donors in 2019 and 289 LTs in 2022. In contrast, Ab+ nonviremic DBD donations are rising, with 536 donors and 284 LTs in 2023. The utilization rate of viremic DBD grafts has continuously decreased despite increased willingness by waitlist candidates to accept them. HCV-positive donation after circulatory death donors were seldom utilized in the study period. The 5-year graft survival rates for HCV-viremic, Ab+ nonviremic, and naïve donors were not significantly different in either DBD ( p = 0.56) or donation after circulatory death ( p = 0.52). Furthermore, Ishak stage 2 or 3 fibrotic DBD grafts had similar 5-year graft survival to nonfibrotic grafts. The findings suggest that the long-term outcome of using HCV-viremic DBD or donation after circulatory death grafts for HCV-negative recipients is comparable to that of other graft types and that fibrotic grafts have the potential to expand the DBD donor pool.
肝移植（LT）中使用丙型肝炎病毒（HCV）阳性供体对HCV阴性受者的长期预后尚未明确。分析了器官共享联合网络（UNOS）数据库在2015年7月1日至2023年12月31日期间的数据。该队列包括44447名接受已故供体肝移植的HCV抗体阴性（Ab-）候选者。评估了分为HCV病毒血症（核酸检测阳性，NAT+）或Ab+非病毒血症（Ab+/NAT-）的HCV阳性供体的病例数和利用率变化。采用Kaplan-Meier分析和倾向评分匹配来评估5年移植物存活率。脑死亡（DBD）供体的HCV病毒血症捐献数量及其在HCV Ab-受者肝移植中的使用在2019年达到640例供体的峰值，在2022年达到289例肝移植的峰值。相比之下，Ab+非病毒血症DBD捐献数量在增加，2023年有536例供体和284例肝移植。尽管等待名单上的候选者接受病毒血症DBD移植物的意愿增加，但病毒血症DBD移植物的利用率持续下降。在研究期间，循环死亡后供体的HCV阳性捐献很少被使用。在DBD（p = 0.56）或循环死亡后捐献（p = 0.52）中，HCV病毒血症、Ab+非病毒血症和未感染供体的5年移植物存活率无显著差异。此外，Ishak 2期或3期纤维化DBD移植物的5年移植物存活率与非纤维化移植物相似。研究结果表明，使用HCV病毒血症DBD或循环死亡后捐献的移植物对HCV阴性受者的长期预后与其他移植物类型相当，并且纤维化移植物有可能扩大DBD供体库。
