The effect of pulsatile pump perfusion on hepatitis C transmission in kidney transplantation: A prospective pilot study.
antibiotic: antiviral
infection and infectious agents
kidney (allograft) function/dysfunction
organ perfusion and preservation
viral: hepatitis C
Journal
Clinical transplantation
ISSN: 1399-0012
Titre abrégé: Clin Transplant
Pays: Denmark
ID NLM: 8710240
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
15
04
2020
accepted:
15
05
2020
pubmed:
23
5
2020
medline:
24
6
2021
entrez:
23
5
2020
Statut:
ppublish
Résumé
With increasing utilization of hepatitis C (HCV) viremic donor organs, there may be a role for kidney pump perfusion to reduce viral load and prevent HCV transmission. We performed a prospective pilot study of HCV viremic donors; one kidney from each donor pair was pumped with perfusate exchanges and viral load testing at least every 4 hours. Donor, recipient, and transplant characteristics were obtained with clinical outcomes. Linear regression was performed to quantify the association between pump time and perfusate viral load. Six HCV viremic donors for six pairs of aviremic recipients were included. Perfusate of the pumped kidneys showed detectable virus throughout the pump cycles. Although perfusate viral levels decreased with increasing pump times, this was not statistically significant (β = -.48, P = .36). All recipients had detectable HCV RNA postoperatively. The pumped cohort had an insignificantly reduced mean viral load compared to pumped recipients (1352 ± 2006 vs 26 170 ± 61 211, P = .09). Time to initiation of direct-acting antiviral was 32 ± 12 vs 26 ± 7 days (P = .17) and to undetectable levels was 66 ± 27 vs 55 ± 22 days (P = .82) for the pumped and unpumped cohorts, respectively. Pulsatile perfusion alone does not appear adequate to decrease HCV transmission. Future studies will need to explore additional ex vivo interventions to pumping.
Substances chimiques
Antiviral Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13987Informations de copyright
© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
Wolfe RA, Ashby VB, Milford EL, et al. Comparison of morality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341(23):1725-1730.
Rabbat CG, Thorpe KE, Russell JD, Churchill DN. Comparison of mortality risk of dialysis patients and cadaveric first renal transplant recipients in Ontario, Canada. J Am Soc Nephrol. 2000;11(5):917-922.
Ogutmen B, Yildrim A, Sever MS, et al. Health-related quality of life after kidney transplantation in comparison intermittent hemodialysis, peritoneal dialysis, and normal controls. Transplant Proc. 2006;38(2):419-421.
Eggers P. Comparison of treatment costs between dialysis and transplantation. Semin Nephrol. 1992;12:284-289.
Hart A, Smith JM, Skeans MA, et al. OPTN/SRTR 2016 annual data report: kidney. Am J Transplant. 2018;18(Suppl 1):18-113.
Durand CM, Bowring MG, Thomas AG, et al. The drug overdose epidemic and deceased-donor transplantation in the United States: a National Registry Study. Ann Intern Med. 2018;168(10):702-711.
Gonzalez SA, Trotter JF. The rise of the opioid epidemic and hepatitis C-positive organs: a new era in liver transplantation. Hepatology. 2018;67(4):1600-1608.
Goldberg DS, Blumberg E, McCauley M, Abt P, Levine M. Improving organ utilization to help overcome the tragedies of the opioid epidemic. Am J Transplant. 2016;16(10):2836-2841.
Afdhal N, Zeuzem S, Kwo P, et al. Ledipasvir and sofosbuvir for untreated HCV genotype 1 infection. N Engl J Med. 2014;370(20):1889-1898.
Afdhal N, Reddy KR, Nelson DR, et al. Ledipasvir and sofosbuvir for previously treated HCV genotype 1 infection. N Engl J Med. 2014;370(16):1483-1493.
Foster GR, Afdha N, Roberts SK, et al. Sofosbuvir and velpatasvir for HCV genotype 2 and 3 infection. N Engl J Med. 2015;373(27):2608-2617.
Reese PP, Abt PL, Blumberg EA, et al. Twelve-month outcomes after transplant of hepatitis C-infected kidneys into uninfected recipients: a single-group trial. Ann Intern Med. 2018;169(5):273-281.
Goldberg DS, Abt PL, Blumberg EA, et al. Trial of transplantation of HCV-infected kidneys into uninfected recipients. N Engl J Med. 2017;376(24):2394-2395.
Durand CM, Bowring MG, Brown DM, et al. Direct-acting antiviral prophylaxis in kidney transplantation from hepatitis C virus-infected donors to noninfected recipients: an open-label nonrandomized trial. Ann Intern Med. 2018;168(8):533-540.
Molnar MZ, Nair S, Csepreka O, et al. Transplantation of kidneys from hepatitis-C infected donors to hepatitis C-infected recipients: single center experience. Am J Transplant. 2019;19(11):3046-3057.
Kapila N, Menon KVN, Al-Khalloufi K, et al. HCV NAT positive solid organ allografts transplanted into HCV negative recipients: a real-world experience. Hepatology. 2019. https://doi.org/10.1002/HEP.31011. Accessed May 5, 2020.
Belzer F. Organ preservation: A personal perspective. In P.I. Teraski (Ed.), History of transplantation: Thirty-five recollections . Los Angeles: UCLA Tissue Typing Laboratory. 1991; 595-613.
Guarrera JV, Nasr SH, Reverte CM, et al. Microscopic intrarenal particles after pulsatile machine preservation do not adversely affect outcomes after renal transplantation. Transplant Proc. 2006;38(10):3384-3387.
Plata-Munoz J, Muthusamy A, Quiroga I, et al. Impact of pulsatile perfusion on postoperative outcomes of kidneys from controlled donors after cardiac death. Transplant Intl. 2008;21(9):899-907.
Moers C, Smith J, Maathuis M, et al. Machine perfusion of cold storage in deceased donor kidney transplantation. N Engl J Med. 2009;360(1):7-19.
Zucker K, Cirocco R, Roth D, et al. Depletion of hepatitis C virus from procured kidneys using pulsatile perfusion preservation. Transplantation. 1994;57:832-840.
Roth D, Zucker K, Cirocco R, et al. Transmission of hepatitis C virus by kidney transplantation: impact of perfusion techniques and course of viremia post transplant. Ped Neph. 1995;9:S29-34.
Tesi RJ, Waller K, Morgan CJ, et al. Transmission of hepatitis C by kidney transplantation-the risks. Transplantation. 1994;57(6):826-831.
La Hoz RM, Sandikci B, Ariyamuthu VK, et al. Short-term outcomes of deceased donor renal transplants of HCV uninfected recipients from HCV seropositive nonviremic donors and viremic donors in the era of direct-acting antivirals. Am J Transplant. 2019;19(11):3058-3070.
Cypel M, Feld JJ, Galasso M, et al. Prevention of viral transmission during lung transplantation with hepatitis C-viraemic donors: an open-label, single-centre, pilot trial. Lancet Respir Med. 2020;8(2):192-201.
Galasso M, Feld JJ, Watanabe Y, et al. Inactivating hepatitis C virus in donor lungs using light therapies during normothermic ex vivo lung perfusion. Nat Commun. 2019;10:481.
Helfritz FA, Bojkova D, Wanders V, et al. Methylene blue treatment of grafts during cold ischemia time reduces the risk of hepatitis C virus transmission. J Infect Dis. 2018;218(11):1711-1721.