Jefferson M Jones, Ian Kracalik, Marilyn E Levi, James S Bowman, James J Berger, Danae Bixler, Kate Buchacz, Anne Moorman, John T Brooks, Sridhar V Basavaraju
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Recommendations that have changed since the 2013 PHS guideline include updated criteria for identifying donors at risk for undetected donor HIV, HBV, or HCV infection; the removal of any specific term to characterize donors with HIV, HBV, or HCV infection risk factors; universal organ donor HIV, HBV, and HCV nucleic acid testing; and universal posttransplant monitoring of transplant recipients for HIV, HBV, and HCV infections. The recommendations are to be used by organ procurement organization and transplant programs and are intended to apply only to solid organ donors and recipients and not to donors or recipients of other medical products of human origin (e.g., blood products, tissues, corneas, and breast milk). The recommendations pertain to transplantation of solid organs procured from donors without laboratory evidence of HIV, HBV, or HCV infection. 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引用次数: 56
摘要
本报告的建议取代了美国公共卫生服务(PHS)关于通过器官移植减少人类免疫缺陷病毒(HIV)、乙型肝炎病毒(HBV)和丙型肝炎病毒(HCV)传播的指南建议(Seem DL, Lee I, Umscheid CA, Kuehnert MJ)。公共卫生服务指南通过器官移植减少人类免疫缺陷病毒、乙型肝炎病毒和丙型肝炎病毒的传播。公共卫生报告2013;128:247-343),以下简称2013年公共卫生服务指南。由于实体器官移植的一些进展,包括普遍实施实体器官供体的HIV、HBV和HCV核酸检测,PHS评估并修订了2013年PHS指南;提高对未被发现的器官供体感染这些病毒的危险因素的认识;以及对这些病毒感染的高效治疗的可用性。PHS征求了相关机构、主题专家、其他利益相关者和公众的反馈意见,以制定修订的指南建议,以确定实体器官供体感染的危险因素,实施实体器官供体的实验室筛查,并监测实体器官移植受者。自2013年小灵通指南以来,建议发生了变化,包括更新了识别有未被发现的供体HIV、HBV或HCV感染风险的供体的标准;删除任何描述献血者具有HIV、HBV或HCV感染危险因素的特定术语;通用器官供体HIV、HBV、HCV核酸检测;以及移植后普遍监测移植受者的HIV、HBV和HCV感染情况。这些建议将由器官采购组织和移植项目使用,并且仅适用于实体器官供体和受体,而不适用于其他人类来源的医疗产品(如血液制品、组织、角膜和母乳)的供体或受体。这些建议涉及从没有HIV、HBV或HCV感染实验室证据的供体获得的实体器官移植。当从有HCV感染实验室证据的供者处获取实体器官时,也包括其他考虑因素,但不要求纳入器官获取和移植网络政策。移植来自丙型肝炎病毒阳性供者器官的移植中心应制定获得知情同意、对受者进行丙型肝炎病毒检测和治疗、确保报销以及向公共卫生当局报告新感染病例的方案。
Assessing Solid Organ Donors and Monitoring Transplant Recipients for Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Infection - U.S. Public Health Service Guideline, 2020.
The recommendations in this report supersede the U.S Public Health Service (PHS) guideline recommendations for reducing transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) through organ transplantation (Seem DL, Lee I, Umscheid CA, Kuehnert MJ. PHS guideline for reducing human immunodeficiency virus, hepatitis B virus, and hepatitis C virus transmission through organ transplantation. Public Health Rep 2013;128:247-343), hereafter referred to as the 2013 PHS guideline. PHS evaluated and revised the 2013 PHS guideline because of several advances in solid organ transplantation, including universal implementation of nucleic acid testing of solid organ donors for HIV, HBV, and HCV; improved understanding of risk factors for undetected organ donor infection with these viruses; and the availability of highly effective treatments for infection with these viruses. PHS solicited feedback from its relevant agencies, subject-matter experts, additional stakeholders, and the public to develop revised guideline recommendations for identification of risk factors for these infections among solid organ donors, implementation of laboratory screening of solid organ donors, and monitoring of solid organ transplant recipients. Recommendations that have changed since the 2013 PHS guideline include updated criteria for identifying donors at risk for undetected donor HIV, HBV, or HCV infection; the removal of any specific term to characterize donors with HIV, HBV, or HCV infection risk factors; universal organ donor HIV, HBV, and HCV nucleic acid testing; and universal posttransplant monitoring of transplant recipients for HIV, HBV, and HCV infections. The recommendations are to be used by organ procurement organization and transplant programs and are intended to apply only to solid organ donors and recipients and not to donors or recipients of other medical products of human origin (e.g., blood products, tissues, corneas, and breast milk). The recommendations pertain to transplantation of solid organs procured from donors without laboratory evidence of HIV, HBV, or HCV infection. Additional considerations when transplanting solid organs procured from donors with laboratory evidence of HCV infection are included but are not required to be incorporated into Organ Procurement and Transplantation Network policy. Transplant centers that transplant organs from HCV-positive donors should develop protocols for obtaining informed consent, testing and treating recipients for HCV, ensuring reimbursement, and reporting new infections to public health authorities.
期刊介绍:
The MMWR series of publications is published by the Office of Science, Centers for Disease Control and Prevention (CDC), U.S.
The MMWR Recommendations and Reports contain in-depth articles that relay policy statements for prevention and treatment in all areas in the CDC’s scope of responsibility (e.g., recommendations from the Advisory Committee on Immunization Practices).