Charlton M, Seaberg E
National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database, USA.
Liver Transpl Surg. 1999 Jul;5(4 Suppl 1):S107-14. doi: 10.1053/JTLS005s00107.
Whereas the impact of early (first 6 postoperative weeks) acute cellular rejection on patient survival among liver transplant recipients as a whole has been reported to be favorable, we hypothesized treatment for acute cellular rejection may have differing impacts on patient and graft survival in hepatitis C virus (HCV)-infected and HCV-negative transplant recipients. We studied the impact of immunosuppression and rejection on patient and graft survival among the 166 HCV-infected and 602 HCV-negative transplant recipients enrolled onto the National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database. All data were collected prospectively. The association of early acute cellular rejection with mortality was determined using a Cox proportional hazards model with a time-dependent covariate. Median follow-up was 5.0 years for HCV-infected and 5.2 years for HCV-negative transplant recipients. HCV-infected transplant recipients experienced similar frequencies of acute cellular and steroid-resistant rejection as patients undergoing liver transplantation for most other indications. The mortality risk was significantly increased (relative risk = 2.4; P =.03) for HCV-infected transplant recipients who developed early acute cellular rejection compared with HCV-negative transplant recipients. None of the HCV-infected transplant recipients developed allograft failure secondary to chronic rejection. The choice of calcineurin inhibitor did not affect posttransplantation outcomes. Early acute cellular rejection occurs at similar frequencies in HCV-infected and HCV-negative transplant recipients. Although an episode of early acute cellular rejection is associated with a lower cumulative mortality among HCV-negative transplant recipients, the opposite is true for HCV-infected transplant recipients, who experience an increased risk for mortality after an episode of early acute cellular rejection. The adverse impact of early acute cellular rejection on patient survival should be considered in developing primary immunosuppression and acute cellular rejection treatment protocols for HCV-infected transplant recipients.
尽管据报道，早期（术后前6周）急性细胞排斥反应对肝移植受者总体患者生存率的影响是有利的，但我们推测，急性细胞排斥反应的治疗可能对丙型肝炎病毒（HCV）感染和HCV阴性的移植受者的患者及移植物生存率产生不同影响。我们研究了免疫抑制和排斥反应对166例HCV感染和602例HCV阴性移植受者的患者及移植物生存率的影响，这些患者均被纳入美国国立糖尿病、消化和肾脏疾病研究所肝移植数据库。所有数据均为前瞻性收集。使用具有时间依赖性协变量的Cox比例风险模型确定早期急性细胞排斥反应与死亡率的关联。HCV感染的移植受者中位随访时间为5.0年，HCV阴性的移植受者为5.2年。与因大多数其他适应证接受肝移植的患者相比，HCV感染的移植受者发生急性细胞排斥反应和类固醇抵抗性排斥反应的频率相似。与HCV阴性的移植受者相比，发生早期急性细胞排斥反应的HCV感染移植受者的死亡风险显著增加（相对风险=2.4；P=0.03）。没有HCV感染的移植受者因慢性排斥反应而发生移植物失功。钙调神经磷酸酶抑制剂的选择不影响移植后结局。HCV感染和HCV阴性的移植受者发生早期急性细胞排斥反应的频率相似。虽然早期急性细胞排斥反应发作与HCV阴性移植受者较低的累积死亡率相关，但对于HCV感染的移植受者来说情况相反，他们在早期急性细胞排斥反应发作后死亡风险增加。在为HCV感染的移植受者制定初始免疫抑制和急性细胞排斥反应治疗方案时，应考虑早期急性细胞排斥反应对患者生存的不利影响。
