Kizilbash Sarah J, Evans Michael D, Smith Jodi, Engen Rachel M
Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA.
Department of Biostatistics, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota, USA.
Am J Transplant. 2025 Jun;25(6):1235-1244. doi: 10.1016/j.ajt.2025.01.030. Epub 2025 Jan 24.
Hepatitis C virus (HCV) infection is increasing in prevalence due to the growing opioid epidemic; however, its impact on pediatric kidney transplantation is unknown. This study compared kidney transplant outcomes between HCV-positive and propensity score-weighted HCV-negative pediatric recipients. It also examined HCV-positive kidney utilization for pediatric transplantation in the United States. We used the Scientific Registry of Transplant Recipients to identify pediatric kidney transplants (aged < 18 years) performed between April 1, 1994 and December 1, 2022. We used propensity score weighting to create a group of HCV-negative recipients with characteristics similar to HCV-positive recipients. Odds ratios for delayed graft function and hazard ratio (HR) for patient and graft survival were estimated using logistic and Cox regression models. We found similar delayed graft function rates (13.9% vs 10.3%, P = .14) and no difference in the graft (HR: 1.04, 95% CI: 0.83-1.31, P = .71; 10-year survival 54.9% vs 54.5%) or patient survival (HR: 1.06, 95% CI: 0.58-1.95, P = .84; 10-year survival 93.9% vs 92.0%) between the groups. Four HCV-positive (2.5%), 3 HCV-negative children (0.02%), and 1 (0.05%) child with unknown HCV status received HCV-positive kidneys. We observed no increased risk of graft loss or death in children with HCV infection. The use of HCV-positive donors for pediatric kidney transplantation is rare.
由于阿片类药物流行情况日益严重，丙型肝炎病毒（HCV）感染的患病率正在上升；然而，其对小儿肾移植的影响尚不清楚。本研究比较了HCV阳性和倾向评分加权的HCV阴性小儿肾移植受者的肾移植结局。研究还调查了美国小儿移植中HCV阳性肾脏的利用情况。我们利用移植受者科学登记处来确定1994年4月1日至2022年12月1日期间进行的小儿肾移植（年龄<18岁）。我们使用倾向评分加权来创建一组具有与HCV阳性受者相似特征的HCV阴性受者。使用逻辑回归和Cox回归模型估计移植肾功能延迟的比值比以及患者和移植物存活的风险比（HR）。我们发现两组之间移植肾功能延迟率相似（13.9%对10.3%，P = 0.14），移植物（HR：1.04，95%置信区间：0.83 - 1.31，P = 0.71；10年生存率54.9%对54.5%）或患者生存率（HR：1.06，95%置信区间：0.58 - 1.95，P = 0.84；10年生存率93.9%对92.0%）没有差异。4名HCV阳性（2.5%）、3名HCV阴性儿童（0.02%）和1名（0.05%）HCV状态未知的儿童接受了HCV阳性肾脏。我们观察到HCV感染儿童的移植物丢失或死亡风险没有增加。小儿肾移植使用HCV阳性供体的情况很少见。
