肾移植供才丙型肝炎病毒（HCV）感染状况及移植抗HCV阳性供肾对受者的影响

目的 了解肾移值供者丙型肝炎病毒（HCV）的感染率及移植抗HCV阳性供肾对受者的影响。方法 采用酶联免疫吸附（ELISA）法检测肾移植供、受者的抗HCV;巢式多聚酶链反应（Nest-PCR)法检测HCVRNA;根据供、受者HCV状态将受者分为4组,对各组受者进行1年以上的随访研究。结果 （1）供者HCV的感染率为4.35%;（2）抗HCV阴性的受者,接受抗HCV阳性供肾移植后,有62.5%的抗HCV及HCVRNA转为阳性,术后丙氨酸转氨酶（ALT）水平和肝功能损害发生率明显高于无HCV感染组;（3）将抗HCV阳性的供肾移植给抗HCV阳性的受者,与抗HCV阴性的受者接受抗HCV阳性供肾移植以及与抗HCV阳性的受者接受抗HCV奶性供肾的临床效果相同。结论 （1）移植抗HCV阳性供肾能传播HCV,可影响受者的肝脏病变,但这种影响程度较轻;（2）将抗HCV阳性供肾移植给抗HCV阳性的受者,既不增加传播HCV的危险性,又有扩大供肾来源,是解决我国供肾短缺的一项值得考虑的策略。     

HCV阴性受者接受HCV阳性供肾肾移植临床研究现状

慢性丙型肝炎病毒（HCV）感染者的抗病毒治疗已经进入直接抗病毒药物（DAA）时代,高达95%的患者可获得临床治愈,在这样的背景下,HCV感染从肾移植手术相对禁忌证逐渐变为手术适应证。然而,目前国内报道的供者或受者HCV感染肾移植数量相当有限,国外已报道的不少HCV阴性受者接受HCV阳性供肾肾移植短期随访数据证实,在DAA治疗下该类型肾移植HCV感染治愈率高,安全性良好,且短期受者生存及移植物结局理想,但目前缺乏大样本、长随访期的临床研究进一步验证HCV感染肾移植的长期安全性。本文就DAA干预下HCV阴性受者接受HCV阳性供肾的病毒学清除、移植物结局及肾移植受者DAA使用的安全性等问题进行探讨,评价这种移植方式的临床安全性和有效性,提高对HCV阳性器官安全使用的认识。     

中枢神经系统肿瘤供肾移植36例报告并文献复习

目的:评估中枢神经系统(CNS)肿瘤供肾移植术后受者肿瘤传播的风险并提出利用策略。方法:回顾性分析18例CNS肿瘤供者以及接受其供肾的36例肾移植受者临床和随访资料。结果:36例CNS肿瘤供肾移植取得良好移植效果,平均随访20个月,未发生供者肿瘤通过肾移植传播给受者的情况。结论:CNS肿瘤供肾移植虽然面临肿瘤通过器官移植传播给受者的潜在风险,但这种风险极低,总体是安全的。     

肾移植受者无细胞血样中出现供受者来源的DNA微嵌合体(英文)

目的:以往研究提示肾移植受者体内有供受者来源的 DNA 微嵌合体出现。但其是否可作为移植肾脏存活状况的预测指标尚未确认,主要是缺少足够的例数。方法:用 RT-PCR 预测性地检测126例曾接受男性肾移植的女性血浆中的 Y 染色体基因 SRY_1、DYZ~(1st)、DYZ~(2nd)。结果:在这126例女性肾移植受者的血浆中SRY_1、DYZ~(1st)、DYZ~(2nd)基因阳性率为77%。微嵌合体阳性受者的移植肾存活率为8.7年;而阴性受者的移植肾存活率为5.4年。出现急性肾排斥反应的阳性受者为10%,而阴性受者为28%。结论:肾移植受者血浆中可以有供者 DNA 微嵌合体出现。利用 RT-PCR 手段检测血浆中微嵌合体可成为移植肾的存活状况预测指标。     

肾移植术后供者特异性抗体对移植肾近期效果的影响

目的 评价肾移植术后供者特异性抗体(Ds-Ab)对移植肾近期效果的影响。方法 对2001年1月至2002年7月间进行尸肾移植的92例受者，使用酶联免疫吸附(ELISA)法，检测受者血清中HLA抗体水平，随访1年。结果 16例(17．4％)受者术后出现供者特异性抗体。抗体阳性组急性排斥发生率(56．3％)高于抗体阴性组(11．9％)，P=0．000；移植肾功能延迟恢复的发生率(12．5％)与抗体阴性组(9．2％)比较，差异无显著性，P=0．102；供者特异性抗体阳性组受者发生急性排斥后，移植肾肌酐水平高于抗体阴性组或无急性排斥组。结论 供者特异性抗体与肾移植术后急性排斥有关，可能影响近期移植肾功能。     

丙型肝炎病毒感染对肾移植受者排斥反应及人/肾存活率的影响

目的 研究丙型肝炎病毒(HCV)感染是否影响移植肾急性和慢性排斥反应的发生率,以及受者和移植肾的存活率.方法 对1992年6月至2004年6月所行肾移植的495例受者进行了随访,其中术前HCV抗体阳性受者27例(HCV阳性组),随机抽取HCV抗体阴性受者27例作为对照组,行组间配对研究,分析HCV感染状态对肾移植受者急性和慢性排斥反应发生率以及人/肾存活率的影响.结果 HCV阳性组受者急性排斥反应的发生率显著高于对照组(19.14%和6.38%,P<0.01),HCV阳性组慢性排斥反应的发生率也明显高于对照组(23.40%和12.76%,P<0.01),对照组肾移植后1、3、5年人/肾存活率显著高于HCV阳性组,差异有统计学意义(P<0.01).结论 HCV感染可以明显增加肾移植受者急性和慢性排斥反应的发生率,降低人/肾存活率.     

补体依赖-流式细胞术-淋巴细胞毒交叉配型实验方法的研究

目的提高识别介导肾移植术后严重排斥反应的抗供者HLA抗原IgG类抗体的准确性,建立补体依赖-流式细胞术-淋巴细胞毒交叉配型(Flow-CDC)实验方法。方法62例等待肾移植受者的血清,分别与33份供者淋巴细胞进行100次经典补体依赖微量淋巴细胞毒交叉配型(NIH-CDC)及Flow-CDC实验,依照受者移植前PRA分为PRA阴性组(25例)和PRA阳性组(75例),比较方法学差异;并观察5例PRA阳性受者的NIH-CDC、Flow-CDC及临床肾移植效果。结果PRA阴性组NIH-CDC与Flow-CDC均为阴性;PRA阳性组中,NIH-CDC阳性24例(32.0%),Flow-CDC阳性31例(41.3%),2种CDC方法阳性率比较差异有统计学意义(χ2=5.14,P=0.016)。100例CDC中,NIH-CDC与Flow-CDC结果吻合率93%,相关系数0.80。4例接受NIH-CDC和Flow-CDC均阴性的供肾PRA阳性患者,术后未发生排斥,近期效果良好;另1例PRA阳性患者接受了NIH-CDC阴性Flow-CDC阳性肾移植,术后发生加速排斥反应而丧失移植肾。结论Flow-CDC能特异性识别针对供者H...     

高致敏Rh阴性受者二次接受Rh阳性供肾移植一例

正近年来,随着Rh血型不合肾移植的开展,如何确保术后移植肾长期存活已成为肾移植领域的重要课题[1]。我国Rh阴性血型较罕见,故Rh阴性肾移植受者寻找同型供肾非常困难。近年来,国内部分移植中心已有多例关于Rh阴性受者成功接受Rh阳性供肾移植的报道[1-2],但群体反应性抗体(panel reactive antibody,PRA)高敏Rh阴性受者二次接受Rh阳性供肾移植国内尚未见报道。本研究回顾性     

Flow-CDC在临床肾移植中应用的初步探讨

目的为了提高交叉配型试验(CDC)对致敏受者肾移植严重排斥反应的预测能力。方法采用Flow-CDC和NIH-CDC技术对96例等候肾移植受者与69份供者进行实验方法比较和肾移植术后排斥反应的相关性观察。结果方法学分析显示,PRA阴性组(32例)Flow-CDC与NIH-CDC均为阴性,吻合率100%;PRA阳性组(64例)Flow-CDC阳性率38.5%(42/109)与NIH-CDC阳性率23.9%(26/109)之间呈显著性差异(χ2=14.06,p<0.001),两种方法间吻合率为85.3%(93/109),即有16次实验结果是NIH-CDC阴性而Flow-CDC阳性。Flow-CDC阳性率在PRA≤10%、11%～30%、≥30%组中分别为0、38.98%和90.48%。以NIH-CDC阴性为入选标准的34例临床移植中,接受Flow-CDC阴性供肾的受者33例,术后仅1例 5d出现急性排斥经冲击治疗后逆转,Scr平均恢复时间为 6d;接受Flow-CDC阳性供肾1例, 2d发生加速排斥, 10d丧失移植肾。结论Flow-CDC与NIH-CDC两种实验技术结果吻合率的差异与PRA强关联,对于PRA阳性受者来说,Flow-CDC的敏感性比NIH-CDC高14.7%,前者能够识别具有补体结合能力的抗供者特异性HLA抗体,更敏感和更准确地预测排斥反应。临床移植效果观察到接受Flow-CDC阴性供肾的33例肾移植受者中1例急排,接受Flow-CDC阳性的1例肾移植受者因加速排斥而丧失了移植物。研究提示,Flow-CDC是一种具有电子化操作、结果客观和直观、可实现SOP等优点的新的交叉配型技术。     

DCD时代肾移植术后耐碳青霉烯类肺炎克雷伯菌感染的治疗经验总结

目的总结心脏死亡器官捐献(DCD)时代肾移植术后耐碳青霉烯类肺炎克雷伯菌(CRKP)感染的临床治疗经验。方法回顾性分析2015年1月至2019年1月行DCD供肾移植术后CRKP感染的17例受者和10例供者临床资料。供、受者均行细菌培养和药敏试验;记录CRKP感染受者的临床表现、治疗及转归情况。结果 7例供者感染CRKP,对其预处理后,2例供者CRKP转阴,5例供者CRKP未转阴。所有供肾均接受替加环素+美罗培南+伏立康唑灌洗预防感染。17例CRKP感染的受者中,包括11例血培养阳性、10例尿培养阳性、3例痰培养阳性、3例切口分泌物阳性、3例腹膜后引流液阳性;其临床表现包括发热8例、移植肾动脉破裂出血7例或移植肾动脉内血栓形成1例、膀胱刺激征3例、咳砖红色胶冻样痰1例。接受替加环素+美罗培南治疗5例,移植肾丢失1例,受者死亡4例;接受头孢他啶-阿维巴坦+美罗培南治疗12例,移植肾丢失3例,受者死亡1例。结论 CRKP感染供者并非肾移植的绝对禁忌证,提前处理供者感染,受者术后早期给予足量敏感抗生素可以治愈感染,改善肾移植受者预后。     

Transplantation of kidneys from HCV-positive donors: a safe strategy?

Hepatitis C Virus (HCV) infection is the most important cause of liver disease after renal transplantation (RT). The impact of HCV on patient and graft survival after RT remains controversial; however, the great majority of studies with large size and adequate follow-up have shown the detrimental impact of HCV on long-term patient and graft survival after RT. The use of kidneys from anti-HCV positive donors could help decrease the continuing disparity between the number of patients on the transplant waiting list and the number of patients receiving a transplant each year. Single-center experiences have suggested transplanting kidneys from anti-HCV positive donors only in anti-HCV positive dialysis patients. Such practice has not demonstrated any adverse effect on the short-term patient survival; the waiting times for RT were shortened. A better alternative seems to be a policy of transplanting kidneys from anti-HCV positive donors only in HCV RNA positive recipients. This requires HCV RNA testing of all anti-HCV positive dialysis patients awaiting RT. Matching donors and recipients for HCV genotype has been suggested; however, the assessment of donor HCV genotype is currently hampered by time constraints. Recent evidence based on large data base demonstrated that RT recipients of HCV-positive donors are at independent increased risk of mortality; unadjusted 3-year patient survival was 85% versus 93% (P=0.01) in all recipients of donor HCV-positive and HCV-negative kidneys, respectively. This was observed in all recipient subgroups including elderly and HCV-positive recipients. In the near future, rapid nucleic acid testing (NAT) of donors and recipients will allow the assessment of the HCV viremic status in order to maximize organ use. With appropriate informed consent, use of a renal graft from an HCV positive donor may be offered to an HCV infected recipient. Additional studies are needed to clarify the link between donor HCV-positive kidneys and patient mortality.     

Chronic liver disease in kidney recipients with hepatitis C virus infection

BACKGROUND: The prevalence of anti-hepatitis C virus (HCV) positive test is higher among patients in dialysis and in kidney recipients than in general population. Hepatitis C virus infection is the main cause of chronic liver disease in renal transplant patients. Liver biopsy and virological analysis were performed to clarify the grade of liver damage in kidney recipients. METHODS: Renal recipients patients with at least 5 yr under immunosuppression were submitted to clinical and laboratory analysis. Patients who tested anti-HCV positive were candidates to liver biopsy with no regard to transaminase levels. RESULTS: Forty-five patients tested anti-HCV positive and 42 anti-HCV negative. Twenty-six anti-HCV and RNA-HCV positive patients were submitted to liver biopsy. Seventy-three percentage of these patients presented chronic active hepatitis, from these only one patient presented cirrhosis. Only 29% of the anti-HCV positive group presented elevated alanine aminotransferase levels. Anti-HCV positive patients presented longer previous time on dialysis and less rejection episodes than the group anti-HCV negative (p < 0.05). All anti-HCV positive patients but one tested RNA-HCV positive by polymerase chain reaction (PCR). CONCLUSIONS: In this series the prevalence of anti-HCV positive is 51.7%. Most of the patients presented liver damage in histology caused by HCV. However, we found only mild or minimal fibrosis and inflammatory activity grade, despite 10 yr of HCV infection and 5 yr of immunosuppressive treatment. Only one patient presented cirrhosis (4%). Performing serial liver biopsies in a long-term follow-up is needed to clarify the impact of HCV infection in renal transplant patients.     

Hepatitis C virus infection among kidney transplant recipients.

The extent of hepatitis C virus (HCV) infection among kidney recipients was investigated in 67 patients by testing for anti-HCV paired serum samples, collected at time of transplantation and during follow-up (average 32 +/- 20 months). Prevalence of anti-HCV at transplant time was 48%, and was related to the time on dialysis and to the amount of blood transfusions. Following transplantation, nine (28%) seropositive patients lost anti-HCV and five (14%), previously seronegative, seroconverted. Anti-HCV was found to be positive in 92% of the patients with chronic liver disease who were on hemodialysis, but in 56% in kidney recipients with chronic hepatitis. Anti-HCV was positive in 50% of patients with resolving hepatitis before transplantation, but only in 21% of those with acute hepatitis following transplantation. This study confirms the high risk of HCV infection among hemodialysis and kidney recipient populations, and also that HCV is closely related with the length of time the patient is on hemodialysis as well as the number of blood units transfused. HCV is the main cause of acute and chronic liver disease in hemodialysis patients and of chronic liver disease in kidney recipients, but does not clearly influence the survival of the allograft nor that of patients.     

Prevalence of anti-HCV in patients on long-term hemodialysis

The prevalence of hepatitis C virus (HCV) infection in patients with long-term hemodialysis (HD) in Japan was assessed using an Ortho HCV Antibody ELISA TEST system. Out of 51 patients, 48 of whom had a history of blood transfusions, 15 (29%) were positive for anti-HCV. This figure is much higher than that in other countries (1-20%), and the difference may reflect a select population. Six (33%) of 18 HD patients with chronic hepatic disease were anti-HCV positive. On the other hand, the prevalence of hepatitis B virus (HBV) markers was 39% (20/51), and 7 (35%) of these 20 with HBV markers were also positive for HCV. The prevalence of anti-HCV showed no relation to the duration of HD treatment. Although a correlation between the prevalence and the blood units transfused was not demonstrated, anti-HCV positive patients had received blood transfusions amounting to significantly more units than those given to negative patients. Anti-HCV was detected in approximately one-third of patients with long-term HD, indicating a lower prevalence of HCV infection as compared to that of HBV infection, and patients with hepatitis of type C accounted for about one-third of HD patients with chronic hepatic disease.     

Detection of antibody to hepatitis C virus in renal transplant recipients.

Non-A, non-B hepatitis is a significant cause of liver disease among renal allograft recipients. In order to assess the impact and prevalence of hepatitis C in a series of renal allograft recipients, we retrospectively screened 621 consecutive patients transplanted between 1979 and 1989 and 484 cadaver organ donors retrieved in the same interval for serologic evidence of hepatitis C viral (HCV) infection using the enzyme-linked assay for anti-HCV antibody. Of 596 HBsAg negative patients, 180 (30%) were anti-HCV positive at the time of transplant. One-year posttransplant, 117 (22%) had detectable levels of anti-HCV antibody. Chemically significant hepatitis developed in 52/234 (22%) anti-HCV positive patients, and 26 of these followed a clinical course consistent with chronic hepatitis. Significantly more males and patients with antibody to HCV detectable at 1 year posttransplant were in the group experiencing an increase in liver enzymes. Ten-year patient and graft survival was 78% and 50%, respectively, for the anti-HCV positive patients who had an elevation of alanine aminotransferase, and 76% and 57% for the cohort maintaining normal liver function (P = NS). There were also no differences in patient and graft survival among the anti-HCV positive group and the consistently sero-negative patients. Of 484 cadaver organ donors with serum available for analysis (out of 1200 retrieved), 67 (14%) were anti-HCV positive at the time of organ donation. Among 23 anti-HCV negative kidney recipients who received a kidney from an HCV antibody positive donor, only one had seroconverted at 1 year posttransplant. Antibody to HCV appears to be widespread among renal transplant recipients and cadaver organ donors. We were unable to demonstrate any evidence of long-term adverse effects on patient and graft survival among anti-HCV positive patients employing the first generation anti-HCV assay.     

乙型肝炎病毒和丙型肝炎病毒感染对肾移植受者长期存活的影响

对乙型肝炎病毒表面抗原阳性与丙型肝炎病毒抗体阳性的肾移植患者慢性肝脏疾病的发病情况进行研究，以探讨肝炎病毒感染对肾移植患者的患乾。结果表明，ＨＢｓＡｇ阳性或ＨＣＶ抗体阳性患者慢性直脏疾病的发病率明显高于阴性患者，但其对人／肾１年存活率的影响不显著；     

Allograft transmission of hepatitis C virus infection from infected donors in cardiac transplantation

BACKGROUND: The frequency and outcome of hepatitis C virus (HCV) infection in recipients of hearts from HCV-infected donors remains poorly characterized. METHODS: Between 1991 and 1999, 10 anti-HCV-negative patients received hearts from donors who were anti-HCV and HCV RNA-positive. Each recipient was tested for anti-HCV and HCV RNA and serially evaluated for liver dysfunction. Recipient records were reviewed for cumulative steroid boluses in the first posttransplant year and other components of the immune suppression regimen. We analyzed recipient outcome in relation to the virologic status of the donor, including the level of HCV RNA and genotype and the type of antirejection therapy. RESULTS: All 10 recipients became HCV RNA positive. Donor-recipient pairs expressed identical genotypes in each instance. Six of nine evaluable recipients developed biochemical evidence of hepatitis. Recipients with genotype 1 (1a, 1b) accounted for five of the six cases, and all patients with genotype 1 developed hepatitis. Severe liver injury occurred in two patients. Two deaths occurred, both of which were genotype 1 patients who had been given multiple boluses of corticosteroids in the first posttransplant year. No definite relationship between viral load in the donor and recipient outcome was found. CONCLUSION: Transmission of HCV infection from cardiac donors who are viremic at the time of organ donation occurs with high frequency and can cause severe hepatitis. Hearts from infected patients should probably be restricted to those recipients who already have evidence for hepatitis C or are in need of emergent transplantation.     

The clinical outcome of hepatitis C virus antibody-positive renal allograft recipients.

In order to investigate the prevalence of antibody to hepatitis C virus (anti-HCV) in renal transplant patients, the evolution of anti-HCV status, and clinical outcome in anti-HCV-positive renal allograft recipients, we tested the sera from 120 renal transplant patients for anti-HCV. Thirty-eight patients were hepatitis B surface antigen (HBsAg)-positive. Two patients were anti-delta-positive. A total of 79 patients (65.8%) had at least one serum positive for anti-HCV. Anti-HCV positivity decreased after transplantation for more than 5 years (65.5% at transplantation versus 37.9%, 78.3 +/- 13.4 months later). Among those with positive anti-HCV, the HBsAg-positive group had significantly higher incidence of chronic hepatitis (50% vs. 25.5%, P = 0.026) and liver cirrhosis (21.4% vs. 0%, P = 0.001) than HBsAg-negative group. Among the 82 HBsAg-negative patients, the prevalence of anti-HCV was significantly higher in those with chronic hepatitis than in those without (86.7% vs. 56.7%, P = 0.027). We conclude from this study: (1) anti-HCV positivity is quite prevalent in renal transplant patients; (2) coinfection of hepatitis B virus (HBV) and hepatitis C virus (HCV) may lead to aggressive liver disease and cirrhosis; HCV infection alone has a more benign clinical outcome; and (3) HCV infection is an important cause of posttransplant chronic hepatitis in HBsAg-negative patients.     

Infection of hepatitis C virus in patients with chronic renal failure undergoing hemodialysis therapy and staff members]

The prevalence of antibody to hepatitis C virus (anti-HCV) was determined in 564 patients and 145 staff members of nine hemodialysis (HD) units in Nagano Prefecture using an enzyme-linked immunosorbent assay based on the C 100 HCV antigen (the first generation anti-HCV assay). And also serum HBV markers were tested in these subjects. One hundred patients (18%) were anti-C100 HCV positive, indicating that this figure represents a much higher prevalence than that (0.9%) among general population in the same geographical area. Out of 141 patients without history of blood transfusion, 17 (12%) were positive for anti-C 100 HCV, suggesting that blood-transfusions-unrelated acquisition of HCV infection can occur. Anti-HCV prevalence correlated with both the blood units transfused and the duration of HD treatment. There was a significant difference in the prevalence of anti-C 100 HCV in individual dialysis units ranging from 0% to 53%. In the dialysis unit with prevalence of 53%, approximately half of the anti-HCV positive patients were found to have chronic liver disease. The prevalence of hepatitis B virus (HBV) markers among HD patients, on the other hand, was 36% (202/564). Fifty one (51%) of 100 anti-C 100 HCV positive patients and 151 (33%) of 464 anti-C 100 HCV negative patients were positive for HBV markers, with significant difference in HBV infection rate between the 2 groups. The prevalence of chronic liver disease, defined as abnormal serum transaminase levels for more than 6 months was significantly higher in anti-HCV positive patients than in anti-HCV negative ones (39% vs 10%, p less than 0.05), suggesting that HCV infection may contribute to chronic liver disease in HD patients. Among 145 staff members, only 3 (2%) were positive for anti-HCV, whereas 25 (17%) were positive for hepatitis B core antibody (anti-HBc), indicating prior HBV infection. With applying the second generation anti-HCV assay, which can detect antibodies to both capsid and nonstructural products of HCV gene, anti-HCV prevalence increased by two times in HD patients, but didn't change in HD staff members.(ABSTRACT TRUNCATED AT 400 WORDS)     

Hepatitis C-positive Donors in Heart Transplantation

Hepatitis C virus (HCV) can be transmitted to heart transplant recipients by donor organs. Mid-term results were reported using HCV-positive donors in patients at risk of imminent death (group I, n = 10), or in patients who otherwise would not have been offered heart transplantation (group II, n = 10) because of age (9/10) or associated medical risk (1/10). Medical records pertaining to patients receiving HCV-positive allografts between July 1994 and December 1999 were reviewed. The recipients consisted of 19 males and one female, with a median age of 54 years for group I and 66 for group II. The HCV RNA level, seroconversion of anti-HCV antibody, biochemical liver dysfunction, and causes of death were examined. Older recipients received reduced immunosuppression. Two patients in group II were HCV positive and were also retransplants. The hospital mortality rate was 10% in group I and 20% in group II; both hepatitis C-positive recipients died postoperatively prior to discharge. All predischarge deaths were related to multi-system organ failure (MSOF). All 17 survivors were HCV negative prior to transplant. Of these, 4/17 seroconverted. HCV RNA was detected in two of them. At a median follow-up of 26.4 months, 2/11 current survivors continue to test anti-HCV positive and are RNA negative. Three-year actual survival was 40% for group I and 70% in group II. Transplant coronary artery disease (TCAD) accounted for one postoperative death in group I. Current data show that four out of 11 survivors had developed TCAD at 3-year follow-up, yielding an actual freedom from TCAD rate of 12/17 (70%) at 3-year follow-up. Hepatitis C transmission using a donor heart as the reservoir is moderate (25%). Limited use of such donors is justified in selected patients. The risk for hepatic disease may be reduced by tailoring immunosuppression specifically for such recipients, particularly if they are at low risk of rejection. Further studies are necessary to define a possible association between HCV and TCAD.