Application status and prospect of organ from hepatitis C donor in solid organ transplantation
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摘要: 丙型病毒性肝炎供者器官作为一种边缘性器官已经被应用于实体器官移植中，在有效缓解器官短缺现况的同时，也面临着一些挑战，如丙型肝炎病毒（HCV）传播。但随着直接抗病毒药物的出现和应用，丙型病毒性肝炎的治愈逐渐成为现实，这也为丙型病毒性肝炎患者成为器官移植供者奠定了基础。目前，在抗病毒药物的辅助治疗下，丙型病毒性肝炎供者实体器官移植取得了一定的疗效。因此，本文总结丙型病毒性肝炎供者肾脏、心脏、肺脏及肝脏等移植的研究现状，就丙型病毒性肝炎供者在实体器官移植中的应用情况及抗病毒药物辅助治疗的安全有效性做一综述，探究丙型病毒性肝炎供者在实体器官移植中可行性，以期为扩大器官移植供体池提供参考，减少终末期疾病患者器官移植的等待时间。Abstract: As a marginal organ donor, organs from hepatitis C donors have been applied in solid organ transplantation. While effectively alleviating the shortage of organs, it also faces certain challenges, such as the spread of hepatitis C virus (HCV). With the emergence and application of direct antiviral drugs, the cure of hepatitis C has gradually become a reality, laying the foundation for hepatitis C patients to become organ transplant donors. At present, with adjuvant treatment using antiviral drugs, certain efficacy has been achieved in solid organ transplantation from hepatitis C donors. In this article, research progress in kidney, heart, lung and liver transplantation from hepatitis C donors, the application of hepatitis C donors in solid organ transplantation and the safety and effectiveness of antiviral drugs were reviewed, and the feasibility of hepatitis C donors in solid organ transplantation was evaluated, aiming to provide reference for expanding the donor pool of organ transplantation and shortening the waiting time for organ transplantation in patients with end-stage diseases.
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表 1 丙肝病毒血症供肝肝移植相关研究
Table 1. Related studies on liver transplantation of liver donors with HCV viremia
研究者 研究时间 入组病例 移植后病毒血症 DAA治疗效果 预后 Elbeshbeshy H, et al[34] 2019年1月至2022年7月 12例，8例病毒血症 —① 11例达到SVR-12，1例复发后继续治疗后治愈 术后1年受者生存率100% Ting PS, et al[35] 2017年1月1日至2019年8月31日 26例，20例病毒血症 病毒血症供肝受者术后全部出现病毒血症，6例非病毒血症供肝受者术后出现2例病毒血症 在完成DAA治疗并进行足够的随访的12例全部达到了SVR-12；其他受者仍在接受DAA治疗，但病毒载量无法检测 在中位随访时间8个月时，25例正常存活，1例因移植前病情过重（MELD评分40分）死亡 Alghamdi W, et al[36] 2018年1月1日至2020年3月31日 5例，3例病毒血症 病毒血症供肝受者全部出现病毒血症，非病毒血症供肝受者没有发生病毒血症 完成治疗的受者全部达到SVR-12 没有出现与DAA治疗相关的重大不良事件；1例受者因脓毒症反复发作，最终死于侵袭性肺曲霉病 Hudson MR, et al[37] 2019年4月1日至2020年5月27日 18例病毒
血症全部受者发生丙肝病毒血症 所有受者均实现HCV清除 1例受者因吻合口并发症死亡，1例受者在DAA治疗过程中出现胃肠道不良反应，其余受者均收获良好结局 Sobotka LA, et al[38] 2017年11月至2020年5月 42例，21例病毒血症 20例病毒血症供肝受者术后确诊病毒血症，2例非病毒血症供肝受者术后出现病毒血症 所有受者均达到SVR-12 1例在开始DAA治疗前死于术后并发症，病毒血症组与非病毒血症组病死率、并发症发生率差异无统计学意义 Aqel B, et al[39] 2018年1月至2019年9月 34例，20例病毒血症 病毒血症供肝受者全部出现病毒血症，非病毒血症供肝受者没有发生病毒血症 所有受者均完成DAA治疗，并达到SVR-12 1例受者发展出丙肝相关的急性膜性肾病,导致终末期肾病，尽管在治疗后实现了病毒清除，仍死于感染性休克；另1例受者在术后610 d死于急性心肌梗死 Anwar N, et al[40] 2018年6月至2019年10月 64例，32例病毒血症 — 19例受者达到SVR-12，其余受者仍在接受治疗，1例尚未开始治疗。未发现治疗失败 病毒血症组与非病毒血症组术后30 d和1年生存率、住院时间、胆道或血管并发症、巨细胞病毒血症差异均无统计学意义 Bohorquez H, et al[41] 2018年6月至2019年12月 292例，61例病毒血症 — 56例受者接受了DAA治疗，51例受者完成DAA治疗，均达到SVR-12 病毒血症组与非病毒血症组术后1年受者和移植物存活率相似 Terrault NA, et al[42] 2018年7月13日至2019年12月21日 13例病毒
血症全部受者发生病毒血症 在治疗的第4周，10例受者检测不到病毒，所有受者均达到SVR-12 — Bethea E, et al[43] 2018年7月至2019年9月 14例，9例病毒血症 9例病毒血症供肝受者和1例非病毒血症受者发生病毒血症 9例病毒血症受者全部达到SVR-12 在中位随访时间46周时，受者存活率为100% Bova S, et al[44] 2017年6月至2019年12月 25例病毒
血症全部受者发生病毒血症 完成治疗的所有受者均达到治愈 1例受者在HCV清除前死亡，原因与丙肝供肝无关 注：①—为无数据 
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