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Verwendung HBV- oder HCV-infizierter Spenderorgane bei der Leber- und Nierentransplantation

HBV- or HCV-viremic donor organs for liver and kidney transplant

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Zusammenfassung

Die limitierte Verfügbarkeit von Organspendern hat die Verwendung von anti-Hepatitis-B-core(HBc)-positiven Organen erforderlich gemacht, mit dem Risiko einer Reaktivierung und akuten Hepatitis-B-Virus(HBV)-Infektion des Empfängers. Allerdings ermöglicht die Verfügbarkeit effizienter prophylaktischer Therapieregime mittlerweile eine breite und sichere Verwendung von anti-HBc-positiven Organen. Der Einsatz auch von Organen von HBV-surface-Antigen(HBsAg)-Trägern oder aktiv HBV-infizierten Spenden wird hingegen als problematisch eingeschätzt und sollte nach individueller Risiko-Nutzen-Abwägung erfolgen. Die Verwendung von Organen Hepatitis-C-Virus(HCV)-virämischer Spender ist noch umstritten, auch wenn durch die Verfügbarkeit von Interferon(IFN)-freien Kombinationen aus „direct-acting antiviral agents“ (DAA) die HCV-Therapie um ein Wesentliches unkomplizierter und nebenwirkungsärmer geworden ist, zudem kombiniert mit Heilungsraten von annähernd 100 %. Daher muss die Verwendung von HCV-positiven/-virämischen Spenderorganen in neuem Licht diskutiert werden, wobei HCV-positiv den serologischen Nachweis einer ausgeheilten HCV-Infektion bezeichnet und HCV-virämisch oder -infiziert eine aktiv replizierende Infektion mit HCV-RNA-Nachweis. Die Einbeziehung HCV-positiver Spenderorgane in die Allokation ist eine interessante Option, den Spenderpool zu erweitern und somit Wartezeiten zur Transplantation und Mortalitätsraten gelisteter Patienten zur reduzieren. Diese Übersicht diskutiert die zur Verfügung stehenden Daten, Herausforderungen und Vorteile hinsichtlich einer erweiterten Verwendung von Organen HBV- und HCV-positiver und -infizierter Spender in der Ära der neuen IFN-freien und hochwirksamen antiviralen Therapien.

Abstract

The small pool of donors has required the use of anti-HBc positive donors, with the resulting possibility of transmitting hepatitis B virus (HBV) from these organs. However, the availability of suitable prophylactic regimens has made the use of anti-HBc positive organs feasible. The use of organs from HBV-surface antigen (HBsAG) carriers or actively HBV-infected individuals is more complex and requires an individual risk–benefit analysis. Grafts from hepatitis C (HCV)-positive donors continues to be the subject of debate. New interferon-free regimens containing direct-acting antiviral agents have fewer adverse effects and better efficacy, making HCV treatment feasible early after transplantation. Thus, solid organ transplantation from HCV positive/-viremic donors must be re-examined, whereby HCV-positive describes the serologic proof of resolved infection and HCV-viremic or -infected an actively replicating infection with proof of HCV-RNA. With interferon-free regimens for HCV infection, expanding the donor pool by including HCV-positive organs is an interesting option that could substantially decrease waiting times and mortality rates for patients listed for transplantation. This review discusses available data, challenges and benefits of using HBV- and HCV-positive and -viremic donor organs in the advent of new antiviral therapeutic options.

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  1. Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland

    K. Herzer

  2. Klinik für Nephrologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland

    U. Eisenberger

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  1. K. Herzer
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K. Herzer und U. Eisenberger geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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G. Gerken, Essen

S. Zeuzem, Frankfurt am Main

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Herzer, K., Eisenberger, U. Verwendung HBV- oder HCV-infizierter Spenderorgane bei der Leber- und Nierentransplantation. Gastroenterologe 14, 260–268 (2019). https://doi.org/10.1007/s11377-019-0362-1

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