Impact of Donor Hepatitis C Virus on Kidney Transplant Outcomes for Hepatitis C-positive Recipients in the Direct-acting Antiviral Era: Time to Revise the Kidney Donor Risk Index?
Impact of Donor Hepatitis C Virus on Kidney Transplant Outcomes for Hepatitis C-positive Recipients in the Direct-acting Antiviral Era: Time to Revise the Kidney Donor Risk Index?
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DOI：
10.1097/tp.0000000000002949
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发表时间：
2020-06-01
期刊：
影响因子：
6.2
通讯作者：
Jones, Christopher M.
中科院分区：
文献类型：
--
作者：
Cannon, Robert M.;Locke, Jayme E.;Jones, Christopher M.
背景：传统上认为来自丙型肝炎病毒（HCV）感染供体的肾脏存在较差生存结局的风险，这反映在肾脏供体特征指数（KDPI）中。现代直接作用的抗病毒药物可能会改变这种风险。方法：使用器官共享联合网络数据，对2014年至2017年HCV感染的成人首次肾移植受者进行了检查。移植物和患者存活率在HCV抗体（Ab）（+）肾与Ab（-）肾的倾向匹配队列中进行比较。随后的分析在HCV病毒血症（RNA阳性）和HCV未感染肾的受者的倾向匹配队列中进行。结果：HCV抗体（+）和HCV抗体（-）肾的受者的匹配队列中各有379名受者。尽管KDPI较高（HCV Ab[+]组为58.2%，HCV Ab[-]组为38.8%），但HCV（+）和HCV（-）组的1年患者和移植物存活率相似（分别为95.4%和94.9%与97.9%和96.0%，P = 0.543和P = 0.834）。HCV-病毒血症组与HCV-初治肾组接受者各有200名接受者，HCV-病毒血症组的KDPI再次较高（56.8%对35.2%）。在病毒血症组中，移植肾衰竭（HR，4.69; P = 0.009）和死亡（HR，7.60; P = 0.003）的基线风险比（HR）显著升高，但在21和24个月时分别超过1。供体病毒血症传递了一种早期风险，随着时间的推移似乎会消退。这些结果表明，可能是时候修改肾脏供体风险指数了。
Background.Kidneys from donors with hepatitis C virus (HCV) infection are traditionally considered to be at risk for poorer survival outcomes, as reflected in the kidney donor profile index (KDPI). Modern direct-acting antivirals may modify this risk.Methods.Using United Network for Organ Sharing data, HCV-infected adult first-time kidney transplant recipients from 2014 to 2017 were examined. Graft and patient survival were compared in a propensity-matched cohort of recipients of HCV antibody (Ab)(+) kidneys versus Ab(-) kidneys. Subsequent analysis was performed in a propensity-matched cohort of recipients of HCV-viremic (RNA positive) versus HCV-naive kidneys.Results.There were 379 recipients each in the matched cohort of recipients of HCV Ab(+) versus HCV Ab(-) kidneys. Despite a higher KDPI (58.2% for HCV Ab[+] versus 38.8% for HCV Ab[-]), 1-year patient and graft survival were similar in the HCV(+) and HCV(-) groups (95.4% and 94.9% versus 97.9% and 96.0%, P = 0.543 and P = 0.834, respectively). There were 200 recipients each in the cohort of recipients of HCV-viremic versus HCV-naive kidneys, with the KDPI again higher in the HCV-viremic group (56.8% versus 35.2%). Baseline hazard ratios (HRs) for graft failure (HR, 4.69; P = 0.009) and death (HR, 7.60; P = 0.003) were significantly elevated in the viremic group, but crossed 1 at 21 and 24 months, respectively.Conclusions.In the modern direct-acting antiviral era, calculated likely KDPI overestimates risk kidneys from HCV (+) donors. Donor viremia conveys an early risk which appears to subside over time. These results suggest that it may be time to revise the kidney donor risk index.