Transplantation of kidneys from hepatitis C-positive donors into hepatitis C virus-infected recipients followed by early initiation of direct acting antiviral therapy: a single-center retrospective study
Transplantation of kidneys from hepatitis C-positive donors into hepatitis C virus-infected recipients followed by early initiation of direct acting antiviral therapy: a single-center retrospective study
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DOI：
10.1111/tri.12954
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发表时间：
2017-09-01
影响因子：
3.1
通讯作者：
Roth, David
中科院分区：
文献类型：
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作者：
Bhamidimarri, Kalyan R.;Ladino, Marco;Roth, David
直接作用的抗病毒药物（DAA）的可用性已经改变了丙型肝炎病毒（HCV）感染的治疗。本研究是一个病例系列，报告了25例HCV感染的ESRD患者的结局，这些患者接受了抗HCV阳性的已故器官供体的肾脏，随后在移植后早期接受了DAA治疗。评估了移植时间和DAA治疗的疗效，如在12周时通过持续病毒应答测量的。从联合网络器官共享（UNOS）等待名单上的原始激活日期到移植的中位等待时间为427天;然而，从患者进入UNet（sm）获得HCV阳性报价到移植的中位时间仅为58天。25名患者在移植后早期（中位数125天）开始抗病毒治疗，25名患者中有24名（96%）在12周时达到持续的病毒学应答。13例患者在抗病毒治疗期间需要调整他克莫司剂量以维持治疗水平。从抗HCV阳性的已故供体接受肾脏缩短了HCV感染的肾移植候选人的等待时间。我们建议，抗HCV阳性供体的肾脏应考虑移植到HCV感染的受者，然后移植后早期用DAA药物治疗。
The availability of direct acting antiviral agents (DAA) has transformed the treatment of hepatitis C virus (HCV) infection. The current study is a case series that reports the outcomes from a cohort of twenty-five HCV-infected ESRD patients who received a kidney from an anti-HCV-positive deceased organ donor followed by treatment with DAAs in the early post-transplant period. Time to transplantation and the efficacy of DAA therapy as measured by sustained viral response at 12 weeks were assessed. The median waiting time from original date of activation on the United Network Organ Sharing (UNOS) waiting list until transplantation was 427 days; however, the median time from entering the patient into UNet(sm) for a HCV-positive offer until transplantation was only 58 days. The 25 patients were started on antiviral treatment early post-transplant (median 125 days) and 24 of 25 (96%) achieved a sustained virologic response at 12 weeks. Tacrolimus dose adjustments were required during antiviral treatment in 13 patients to maintain therapeutic levels. Accepting a kidney from an anti-HCV-positive deceased donor shortened the waiting time for HCV-infected kidney transplant candidates. We recommend that kidneys from anti-HCV-positive donors should be considered for transplant into HCV-infected recipients followed by early post-transplant treatment with DAA agents.