医学
荟萃分析
内科学
心脏移植
丙型肝炎病毒
丙型肝炎
移植
传输(电信)
死亡率
免疫学
病毒
电气工程
工程类
作者
Josue Villegas-Galaviz,Eve Anderson,Maya Guglin
标识
DOI:10.1016/j.healun.2022.01.010
摘要
Heart transplantation (HTx) from hepatitis C virus (HCV)-viremic donors to nonviremic recipients decreases mortality and costs. Consequently, many transplant centers have reported their results using this strategy. Hence, there is a need for an outcome analysis.We performed a systematic review with meta-analysis. In August 2020, we searched PubMed and EMBASE for publications containing data of nonviremic recipients who underwent HTx from HCV-viremic donors once direct-acting antiviral (DAA) therapy had become available (≥2014).We identified 398 publications, 13 of which met inclusion criteria, and analyzed the outcomes of 195 recipients. The HCV-transmission rate was >97% but, the cure rate was 100% with DAA therapy. The 6 and 12-month survival were 95.6% and 92.9%, respectively. Of 10 deaths reported, none were associated with HCV infection. The acute cellular rejection (ACR) rate was 31.1%. The overall DAA failure rate was 1.1%, defined as the need to alter the initial DAA therapy due to failure to cure HCV. However, the DAA failure rate was 0% when the DAA therapy was started within the first 2 weeks post-HTx. No statistically significant differences in HCV cure rates, survivals, ACR rates, and DAA failure rates were observed when outcomes were stratified by therapeutic approach type (i.e., a prophylactic approach in which DAA was given to the recipient before confirming HCV-transmission vs a reactive approach, in which DAA was given to the recipient only after an HCV-transmission was confirmed).Excellent clinical outcomes have been observed in nonviremic recipients of HTx from HCV-viremic donors since DAA had become available.
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