JAMA Cardiol:在丙肝直接抗病毒治疗时代扩大心脏移植

2019-12-21 xiangting MedSci原创

在直接抗病毒时代,丙肝阳性供体是扩大供体库的可行选择,可以减少等待时间和死亡率。在患供体来源丙肝的心脏移植受者中,感染耐受良好且可以治愈,1年生存率与丙肝阴性供体的受者相同。

对于等待心脏移植的患者,丙肝阳性供体提供了扩大供体库、缩短等待时间并降低等待死亡率的机会。尽管少数心脏移植受者的早期报告结局不错,但掌握更大患者队列的1年结局对患者就该选择进行共同决策至关重要。

这项研究目的是更好地确定丙肝阳性供体与心脏移植量、等待时间、供体来源丙肝的传播和治愈以及1年死亡率之间的关联。

这是一项前瞻性、单中心观察性研究,研究对象是20169月至20194月在一个大型医疗中心使用丙肝阳性供体心脏进行心脏移植的80名成年患者(≥18岁)。在捐献者中,如果丙肝抗体和/或核酸检测结果阳性,则被认为是丙肝阳性,其中70名患有病毒血症,10名是血清阳性但没有病毒血症。随访至2019515日。与同期接受丙肝阴性供体心脏移植的患者进行比较。

除了标准的移植后治疗外,出现供体来源丙肝感染的移植受者还接受直接抗病毒治疗。

主要结局包括所有患者的等待时间和1年生存率,以及出现供体来源丙肝患者直接抗病毒治疗的反应。

80名患者中,男性57名(71.3%),白人55名(68.7%),黑人17名(26.3%)。移植时的中位年龄为54.5岁(四分位间距为46-62岁)。同意接受丙肝捐献者的心脏后,到心脏移植的中位天数为4天(四分位间距为1-18)。核酸检测结果阴性捐献者(10 [12.5])的受者无一出现供体来源丙肝。中位随访301天内(四分位间距142-617),核酸检测结果阳性捐献者的70名受者中,有67名(95.7%)出现供体来源丙肝。所有接受治疗患者中,直接抗病毒药物的耐受性良好,并产生持续的病毒学应答。感染队列的1年患者生存率为90.4%,与非感染队列或同期接受丙肝阴性供体移植的患者相比,没有显著差异。

在直接抗病毒时代,丙肝阳性供体是扩大供体库的可行选择,可以减少等待时间和死亡率。在患供体来源丙肝的心脏移植受者中,感染耐受良好且可以治愈,1年生存率与丙肝阴性供体的受者相同。

原始出处:

Kelly H. Schlendorf. Expanding Heart Transplant in the Era of Direct-Acting Antiviral Therapy for Hepatitis C. JAMA Cardiology. December 2019.

本文系梅斯医学(MedSci)原创编译整理,转载需授权!

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    2019-12-23 yahu
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    2019-12-21 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

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接受心脏移植的患者死亡风险较高,传统的风险评分在预测移植后存活率方面表现一般,强调了尚未确定的因素在决定预后方面的重要性。本研究的目的旨在评估PM2.5的暴露与心脏移植死亡风险的相关性。本研究纳入分析了UNOS数据库中的21800名接受了心脏移植的患者,随访时间是86713人年,接受心脏移植时的平均年龄为52.6 ± 12.6岁,男性占75%,白种人占69%,39%有缺血性心力衰竭病因。平均对PM