Трансплантация сердца и лёгких от доноров с гепатитом С.
C появлением противовирусных препаратов прямого действия для лечения гепатита С показания к использованию сердца и легких от инфицированных доноров были расширены.
Сердце и легкие доноров с гепатитом С как правило, не использовались для трансплантации. С появлением противовирусных препаратов прямого действия для лечения гепатита С показания к использованию сердца и легких от инфицированных доноров были расширены, что способствовало обеспечению органами гораздо большего числа пациентов, нуждающихся в трансплантации. При этом реципиентам проводят пан-генотипическое противовирусное лечение гепатита С в течение первых 4-х недель, начиная курс через несколько часов после трансплантации и тем самым блокируя репликацию вируса.
В исследовании, проведенном в Brigham and Women's Hospital в Бостоне, приняли участие 44 пациента, 36 из которых была произведена пересадка легких и у 8 было пересажено сердце от инфицированных гепатитом С доноров. Через 6 месяцев все реципиенты были живы, а проблем с функцией трансплантатов не наблюдалось. Вирусная нагрузка стала неопределяемой приблизительно через 2 недели после трансплантации. Также не было выявлено серьезных побочных эффектов, связанных с противовирусным лечением.
Источник https://www.nejm.org/doi/full/10.1056/NEJMoa1812406
Heart and Lung Transplants from HCV-Infected Donors to Uninfected Recipients.
Woolley AE et al
BACKGROUND:
Hearts and lungs from donors with hepatitis C viremia are typically not transplanted. The advent of direct-acting antiviral agents to treat hepatitis C virus (HCV) infection has raised the possibility of substantially increasing the donor organ pool by enabling the transplantation of hearts and lungs from HCV-infected donors into recipients who do not have HCV infection.
METHODS:
We conducted a trial involving transplantation of hearts and lungs from donors who had hepatitis C viremia, irrespective of HCV genotype, to adults without HCV infection. Sofosbuvir-velpatasvir, a pangenotypic direct-acting antiviral regimen, was preemptively administered to the organ recipients for 4 weeks, beginning within a few hours after transplantation, to block viral replication. The primary outcome was a composite of a sustained virologic response at 12 weeks after completion of antiviral therapy for HCV infection and graft survival at 6 months after transplantation.
RESULTS:
A total of 44 patients were enrolled: 36 received lung transplants and 8 received heart transplants. The median viral load in the HCV-infected donors was 890,000 IU per milliliter (interquartile range, 276,000 to 4.63 million). The HCV genotypes were genotype 1 (in 61% of the donors), genotype 2 (in 17%), genotype 3 (in 17%), and indeterminate (in 5%). A total of 42 of 44 recipients (95%) had a detectable hepatitis C viral load immediately after transplantation, with a median of 1800 IU per milliliter (interquartile range, 800 to 6180). Of the first 35 patients enrolled who had completed 6 months of follow-up, all 35 patients (100%; exact 95% confidence interval, 90 to 100) were alive and had excellent graft function and an undetectable hepatitis C viral load at 6 months after transplantation; the viral load became undetectable by approximately 2 weeks after transplantation, and it subsequently remained undetectable in all patients. No treatment-related serious adverse events were identified. More cases of acute cellular rejection for which treatment was indicated occurred in the HCV-infected lung-transplant recipients than in a cohort of patients who received lung transplants from donors who did not have HCV infection. This difference was not significant after adjustment for possible confounders.
CONCLUSIONS:
In patients without HCV infection who received a heart or lung transplant from donors with hepatitis C viremia, treatment with an antiviral regimen for 4 weeks, initiated within a few hours after transplantation, prevented the establishment of HCV infection. (Funded by the Mendez National Institute of Transplantation Foundation and others; DONATE HCV ClinicalTrials.gov number, NCT03086044.).