丙型肝炎阳性捐献者肺移植的长期疗效令人鼓舞：来自 UNOS 登记处的启示。

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-03-14 DOI:10.1016/j.transproceed.2025.02.044

Elizabeth J. Bashian , Eleanor E. Bashian , Ye In Christopher Kwon , Matthew Ambrosio , Zachary Fitch , Lauren J. Taylor , Vipul Patel , Walker Julliard , Vigneshwar Kasirajan , Zubair A. Hashmi

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引用次数: 0

摘要

背景：丙型肝炎病毒（HCV）有效的直接抗病毒治疗（DAAT）的发展为使用HCV+供体提供了可能。我们的目的是评估使用HCV+供体器官进行肺移植的长期可行性。方法：我们使用UNOS数据库对2000年至2023年间的成人肺移植受者进行评估。将HCV阳性器官进一步分为抗体和核酸检测（NAT）均阳性器官和抗体单独检测阳性器官。比较基线受体和供体特征。Kaplan-Meier法评估30天、1年和5年生存率。我们使用多变量Cox回归分析进行风险分析。结果：共进行肺移植41797例，其中HCV+供者945例。HCV+肺受者FEV1较高（P < 0.001），年龄较大（P < 0.001）， BMI较高（P < 0.001）。虽然HCV+和HCV-供体肺受体的5年生存率没有差异（P = 0.093），但HCV+肺受体的移植生存率更高（P = 0.038）。HCV+肺受体的急性排斥反应率也较低（P = 0.018）。然而，HCV+肺受者在移植后使用呼吸机的时间明显更长（P = 0.033）。供体HCV+状态，无论是NAT- (HR 1.03, P = .766)还是NAT+ (HR 0.89, P = .24)，都与不良结局无关。结论：HCV+供体肺移植在移植后5年内具有良好的预后。通过仔细的术前筛查、DAAT治疗和术后管理，HCV+肺受者可能会出现最小的额外并发症。

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Promising Long-Term Outcomes of Lung Transplantation With Hepatitis C Positive Donors: Insights From the UNOS Registry

Background

The development of effective direct-acting antiviral treatment (DAAT) for hepatitis C virus (HCV) has opened the possibility of using HCV+ donors. We aimed to assess the long-term feasibility of lung transplantation using organs from HCV+ donors.

Methods

We used the UNOS database to evaluate adult lung transplant recipients between 2000 and 2023. HCV+ organs were further divided into those positive for both antibody and nucleic acid testing (NAT) or antibody testing alone. Baseline recipient and donor characteristics were compared. The Kaplan–Meier method was used to assess 30-day, 1-year, and 5-year survival. We performed risk analyses using multivariate Cox regression analyses.

Results

41,797 lung transplants were performed, among which 945 used HCV+ donors. Recipients of HCV+ lungs had higher FEV1 (P < .001), older (P < .001), and had higher BMI (P < .001). While 5-year survival did not differ between recipients of HCV+ and HCV- donor lungs (P = .093), graft survival was superior among recipients of HCV+ lungs (P = .038). Acute rejection rates were also lower for recipients of HCV+ lungs (P = .018). However, recipients of HCV+ lungs required significantly higher time on the ventilator post-transplant (P = .033). Donor HCV+ status, regardless of whether they were NAT- (HR 1.03, P = .766) or NAT+ (HR 0.89, P = .24), was not associated with adverse outcomes.

Conclusions

Lung transplantation with HCV+ donor lungs demonstrates promising outcomes up to 5 years post-transplant. With careful preoperative screening, DAAT treatments, and postoperative management, recipients of HCV+ lungs may expect minimal additional complications.

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.