PDF(Pubmed)
Abstract：
Background: Donor hepatitis-C (HCV) infection has historically represented a barrier to kidney transplantation (KT). However, direct-acting antiviral (DAA) medications have revolutionised treatment of chronic HCV infection. Recent American studies have demonstrated that DAA regimes can be used safely peri-operatively in KT to mitigate HCV transmission risk. Methods: To formulate this narrative review, a comprehensive literature search was performed to analyse results of existing clinical trials examining KT from HCV-positive donors to HCV-negative recipients with peri-operative DAA regimes. Results: 13 studies were reviewed (11 single centre, four retrospective). Outcomes for 315 recipients were available across these studies. A sustained virological response at 12 weeks (SVR12) of 100% was achieved in 11 studies. One study employed an ultra-short DAA regime and achieved an SVR12 of 98%, while another achieved SVR12 of 96% due to treatment of a missed mixed genotype. Conclusion: HCV+ KT is safe and may allow increased utilisation of organs for transplantation from HCV+ donors, who often have other favourable characteristics for successful donation. Findings from US clinical trials can be applied to the United Kingdom transplant framework to improve organ utilisation as suggested by the NHSBT vision strategy \"Organ Donation and Transplantation 2030: meeting the need\".
摘要：
背景：供者丙型肝炎（HCV）感染历来是肾移植（KT）的障碍。然而,直接作用抗病毒（DAA）药物彻底改变了慢性HCV感染的治疗方法。最近的美国研究表明，DAA方案可以安全地在KT围手术期使用，以减轻HCV传播风险。方法：制定本叙事综述，我们进行了一项全面的文献检索,以分析现有的临床试验的结果,这些临床试验在接受围手术期DAA治疗的HCV阳性供者和HCV阴性受者之间进行了KT检查.结果：回顾了13项研究(11项单中心，四个回顾性)。在这些研究中，有315名接受者的结果可用。在11项研究中实现了12周时100%的持续病毒学应答(SVR12)。一项研究采用了超短的DAA方案，实现了98%的SVR12，而另一个由于错过的混合基因型的治疗而获得了96％的SVR12。结论：HCV+KT是安全的，可以提高HCV+供体移植器官的利用率，他们通常具有其他成功捐赠的有利特征。美国临床试验的结果可以应用于英国移植框架，以改善NHSBT愿景战略“器官捐献和移植2030：满足需要”所建议的器官利用率。
