Hepatitis C-positive donor liver transplantation for hepatitis C seronegative recipients
Hepatitis C-positive donor liver transplantation for hepatitis C seronegative recipients
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DOI：
10.1111/tid.13194
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发表时间：
2019-10-30
影响因子：
2.6
通讯作者：
Chen, Po-Hung
中科院分区：
文献类型：
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作者：
Ting, Peng-sheng;Hamilton, James Peter;Chen, Po-Hung
在过去的十年中，阿片类药物危机导致丙型肝炎病毒阳性供体的增加。虽然历史上丙型肝炎血清阳性器官通常被丢弃，但直接作用的抗病毒剂的出现显着扩大了对丙型肝炎供体器官的利用。从丙型肝炎血清阳性供体到丙型肝炎血清阳性受体的肝移植（LT）经验越来越多。然而，丙型肝炎血清阳性或丙型肝炎核糖核酸阳性供体对丙型肝炎血清阴性受体进行LT的数据仍然有限。方法我们对2017年1月1日至2019年8月31日在约翰霍普金斯医院综合移植中心接受丙型肝炎血清阳性供体肝脏，随后进行直接作用抗病毒治疗的26名丙型肝炎血清阴性受者进行了回顾性研究。结果26例受者中有25例存活，移植物功能正常;其中20例接受了丙型肝炎核酸检测阳性供体的肝脏。所有12名完成直接作用抗病毒疗程并达到足够的持续病毒学应答随访的受试者均达到了持续病毒学应答。我们的9名受试者要么完成了直接作用的抗病毒治疗，但没有足够的随访时间来获得持续的病毒学应答，要么正在接受直接作用的抗病毒治疗。一名患者正在等待抗病毒治疗开始，等待保险批准。值得注意的是，12例持续病毒学应答的患者中有11例接受了丙型肝炎核酸检测阳性供体肝脏。结论丙型肝炎血清阴性患者接受丙型肝炎血清阳性或丙型肝炎核酸检测阳性的肝移植后，可以享受良好的短期结果，丙型肝炎治愈后直接作用的抗病毒治疗。
Background The opioid crisis has led to an increase in hepatitis C virus-positive donors in the past decade. Whereas historically hepatitis C seropositive organs were routinely discarded, the advent of direct-acting antiviral agents has notably expanded the utilization of organs from donors with hepatitis C. There has been growing experience with liver transplantation (LT) from hepatitis C seropositive donors to hepatitis C seropositive recipients. However, data remain limited on LT from hepatitis C seropositive or hepatitis C ribonucleic acid positive donors to hepatitis C seronegative recipients. Methods We performed a retrospective study of 26 hepatitis C seronegative recipients who received hepatitis C seropositive donor livers followed by preemptive antiviral therapy with direct-acting antiviral treatment at the Johns Hopkins Hospital Comprehensive Transplant Center from January 1, 2017, to August 31, 2019. Results Twenty-five of the 26 recipients are alive with proper graft function; 20 of them received livers from hepatitis C nucleic acid testing positive donors. All 12 recipients who completed their direct-acting antiviral courses and have reached sufficient follow-up for sustained virologic response have achieved sustained virologic response. Nine of our recipients have either completed direct-acting antiviral treatment without sufficient follow-up time for sustained virologic response or are undergoing direct-acting antiviral treatment. One patient is awaiting antiviral treatment initiation pending insurance approval. Of note, 11 of 12 patients with sustained virologic response received a hepatitis C nucleic acid testing positive donor liver. Conclusion Hepatitis C seronegative patients who receive a hepatitis C seropositive or hepatitis C nucleic acid testing positive liver allograft can enjoy good short-term outcomes with hepatitis C cure following direct-acting antiviral treatment.