Donors with human immunodeficiency virus and hepatitis C virus for solid organ transplantation: what's new.
Donors with human immunodeficiency virus and hepatitis C virus for solid organ transplantation: what's new.
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DOI：
10.1097/qco.0000000000000840
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发表时间：
2022-08-01
影响因子：
3.9
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中科院分区：
文献类型：
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《希望法案》的通过和直接作用抗病毒（DAA）疗法的出现使捐献器官库扩大到包括艾滋病毒和丙型肝炎病毒捐献者，从而为等待名单候选人提供了新的机会。本文提供了最新的研究，在实体器官移植利用与艾滋病毒和丙型肝炎病毒的供体。第一批从HIV感染者向HIV感染者（HIV D+/R+）进行肾脏和肝脏移植的试点研究显示，患者存活率很高，移植物存活率与无HIV感染者（HIV D-/R+）的移植相当，并且HIV突破率没有增加。由于几个潜在因素，使用的艾滋病毒D+器官数量低于初步估计数。由于阿片类药物流行导致大量过量死亡，有更多的HCV D+器官可用，导致无HCV（HCV D+/R−）的受体与DAA联合移植。腹部和胸部HCV D+/R移植的结果都很好。随着最近在HIV D+/R+和HCV D+/R− SOT中的良好结果的发现，我们认为证据支持这两种做法作为标准临床护理选择，以缓解器官短缺并降低等待名单死亡率。
Passage of the HOPE Act and the advent of direct-acting antiviral (DAA) therapies have allowed for expansion of the donor organ pool to include donors with HIV and HCV, thus providing new opportunities for waitlist candidates. This article provides updates on recent studies in solid organ transplantation utilizing donors with HIV and HCV. The first pilot studies of kidney and liver transplantation from donors-with-HIV to recipients-with-HIV (HIV D+/R+) show robust patient survival, comparable graft survival to transplantation from donors without HIV (HIV D−/R+) and no increased rates of HIV breakthrough. The number of HIV D+ organs utilized has been lower than initial estimates due to several potential factors. With high numbers of overdose deaths from the opioid epidemic, there have been more HCV D+ organs available, leading to transplantation in recipients without HCV (HCV D+/R−) in combination with DAAs. Outcomes in both abdominal and thoracic HCV D+/R transplantation are excellent. With recent findings of good outcomes in both HIV D+/R+ and HCV D+/R− SOT, we feel the evidence supports both practices as standard clinical care options to mitigate organ shortage and reduce waitlist mortality.