Immediate administration of antiviral therapy after transplantation of hepatitis C-infected livers into uninfected recipients: Implications for therapeutic planning.
Immediate administration of antiviral therapy after transplantation of hepatitis C-infected livers into uninfected recipients: Implications for therapeutic planning.
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DOI：
10.1111/ajt.15768
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发表时间：
2020-06
期刊：
影响因子：
--
通讯作者：
Chung RT
中科院分区：
文献类型：
--
作者：
Bethea E;Arvind A;Gustafson J;Andersson K;Pratt D;Bhan I;Thiim M;Corey K;Bloom P;Markmann J;Yeh H;Elias N;Kimura S;Dageforde LA;Cuenca A;Kawai T;Safa K;Williams W;Gilligan H;Sise M;Fishman J;Kotton C;Kim A;Rogers CC;Shao S;Cote M;Irwin L;Myoung P;Chung RT
移植指南之前并未推荐将感染丙型肝炎 (HCV) 的肝脏移植到未感染 HCV 的受者体内，部分原因是担心同种异体移植物的 HCV 感染不受控制。直接作用抗病毒药物 (DAAs) 为治疗供体来源的 HCV 感染提供了机会，应在移植后早期施用。然而，在更广泛地使用 HCV 阳性供体器官之前，需要有关立即 DAA 治疗方法的安全性和有效性的证据，包括如何管理围绕及时 DAA 采购的后勤障碍。我们报告了一项试验的结果，其中 14 名 HCV 阴性患者成功接受了 HCV 阳性供体的肝移植。 9 名患者接受了病毒血症（核酸检测 (NAT) 阳性）肝脏，并在移植后 5 天内开始了为期 12 周的口服 glecaprevir-pibrentasvir (GP) 疗程。五名患者接受了来自 HCV 抗体阳性非病毒血症供体的肝脏，并采用反应性方法进行随访。中位随访 46 周后，NAT 阳性受者的存活率为 100%。对未感染的受者进行 HCV NAT 阳性肝移植的立即治疗方法是安全有效的。在移植后早期获得付款人对 DAA 的批准，可以根据需要分配 HCV 阳性供体器官，无论候选 HCV 状态如何，同时避免慢性 HCV 同种异体移植物感染。
The practice of transplanting hepatitis C (HCV)-infected livers into HCV-uninfected recipients has not previously been recommended in transplant guidelines, in part because of concerns over uncontrolled HCV infection of the allograft. Direct-acting antivirals (DAAs) provide an opportunity to treat donor derived HCV-infection, and should be administered early in the post-transplant period. However, evidence on the safety and efficacy of an immediate DAA treatment approach, including how to manage logistical barriers surrounding timely DAA procurement, are required prior to broader use of HCV-positive donor organs. We report the results of a trial in which fourteen HCV-negative patients underwent successful liver transplantation from HCV-positive donors. Nine patients received viremic (nucleic acid testing (NAT)-positive) livers, and started a 12-week course of oral glecaprevir-pibrentasvir (GP) within 5 days of transplant. Five patients received livers from HCV antibody-positive non-viremic donors and were followed using a reactive approach. Survival in NAT-positive recipients is 100% at a median follow-up of 46 weeks. An immediate treatment approach for HCV NAT-positive liver transplantation into uninfected recipients is safe and efficacious. Securing payer approval for DAAs early in the post-transplant course could enable need-based allocation of HCV-positive donor organs irrespective of candidate HCV status, while averting chronic HCV allograft infection.
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影响因子：
39.2
作者：
Durand, Christine M.;Bowring, Mary G.;Segev, Dorry L.
通讯作者：
Segev, Dorry L.
DOI：
10.1016/j.cgh.2018.08.042
发表时间：
2019-03
期刊：
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
影响因子：
--
作者：
Bethea ED;Samur S;Kanwal F;Ayer T;Hur C;Roberts MS;Terrault N;Chung RT;Chhatwal J
通讯作者：
Chhatwal J
影响因子：
6.2
作者：
Ballarin, Roberto;Cucchetti, Alessandro;Gerunda, Giorgio Enrico
通讯作者：
Gerunda, Giorgio Enrico
影响因子：
39.2
作者：
Reese, Peter P.;Abt, Peter L.;Goldberg, David S.
通讯作者：
Goldberg, David S.
影响因子：
8.8
作者：
Khan, B.;Singer, L. G.;Cypel, M.
通讯作者：
Cypel, M.