Changes in Utilization and Discard of Hepatitis C-Infected Donor Livers in the Recent Era
Changes in Utilization and Discard of Hepatitis C-Infected Donor Livers in the Recent Era
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DOI：
10.1111/ajt.13976
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发表时间：
2017-02-01
影响因子：
8.8
通讯作者：
Durand, C. M.
中科院分区：
文献类型：
--
作者：
Bowring, M. G.;Kucirka, L. M.;Durand, C. M.
无干扰素（IFN）直接作用抗病毒（DAA）丙型肝炎病毒（HCV）治疗对HCV阳性死亡供体肝移植（DDLT）的利用率和预后的影响在很大程度上是未知的。使用移植受者科学登记处，我们从2005年至2015年确定了25566名hcv阳性DDLT受者，并根据引入DAA疗法使用修正泊松回归比较实践。丙型肝炎病毒感染者接受丙型肝炎病毒阳性肝脏的比例从2010年的6.9%上升到2015年的16.9%。2010年后（早期DAA/IFN时代）hcv阳性接受者接受hcv阳性肝脏的可能性增加61% (aRR: 1.45)1.61（1.79), p < 0.001)， 2013年后（无IFN的DAA时代）接受hcv阳性肝脏的可能性增加近三倍（aRR: 2.58）2.85(3.16), p < 0.001）。与hcv阴性肝脏相比，2005 - 2010年hcv阳性肝脏被丢弃的可能性是阴性肝脏的3倍（aRR: 2.69）2.99(3.34), p < 0.001)， 2010年后是阴性肝脏的2.2倍（aRR: 1.80）2.16（2.58), p < 0.001)， 2013年后是阴性肝脏的1.7倍（aRR: 1.37）1.68(2.04), p < 0.001）。供体HCV状态与全因移植物损失的风险增加无关（p = 0.1），这也没有随时间改变（p = 0.8）。随着daa的出现，丙型肝炎病毒阳性肝脏的使用急剧增加。然而，丢弃率仍然是hcv阴性肝脏的近两倍。进一步优化hcv阳性肝脏的利用是必要的，以提高所有候选人的可及性。
The impact of interferon (IFN)-free direct-acting antiviral (DAA) hepatitis C virus (HCV) treatments on utilization and outcomes associated with HCV-positive deceased donor liver transplantation (DDLT) is largely unknown. Using the Scientific Registry of Transplant Recipients, we identified 25 566 HCV-positive DDLT recipients from 2005 to 2015 and compared practices according to the introduction of DAA therapies using modified Poisson regression. The proportion of HCV-positive recipients who received HCV-positive livers increased from 6.9% in 2010 to 16.9% in 2015. HCV-positive recipients were 61% more likely to receive an HCV-positive liver after 2010 (early DAA/IFN era) (aRR:(1.45)1.61(1.79), p < 0.001) and almost three times more likely to receive one after 2013 (IFN-free DAA era) (aRR:(2.58)2.85(3.16), p < 0.001). Compared to HCV-negative livers, HCV-positive livers were 3 times more likely to be discarded from 2005 to 2010 (aRR:(2.69)2.99(3.34), p < 0.001), 2.2 times more likely after 2010 (aRR:(1.80)2.16(2.58), p < 0.001) and 1.7 times more likely after 2013 (aRR:(1.37)1.68(2.04), p < 0.001). Donor HCV status was not associated with increased risk of all-cause graft loss (p = 0.1), and this did not change over time (p = 0.8). Use of HCV-positive livers has increased dramatically, coinciding with the advent of DAAs. However, the discard rate remains nearly double that of HCV-negative livers. Further optimization of HCV-positive liver utilization is necessary to improve access for all candidates.