欧洲丙型肝炎肝移植术后影响预后因素的协作研究。欧洲病毒性肝炎协调行动组织（EUROHEP）小组。

European collaborative study on factors influencing outcome after liver transplantation for hepatitis C. European Concerted Action on Viral Hepatitis (EUROHEP) Group.

作者信息

Féray C, Caccamo L, Alexander G J, Ducot B, Gugenheim J, Casanovas T, Loinaz C, Gigou M, Burra P, Barkholt L, Esteban R, Bizollon T, Lerut J, Minello-Franza A, Bernard P H, Nachbaur K, Botta-Fridlund D, Bismuth H, Schalm S W, Samuel D

机构信息

Centre Hépato-Biliaire, Hôpital Paul Brousse, CRI 9804, Villejuif, France.

出版信息

Gastroenterology. 1999 Sep;117(3):619-25. doi: 10.1016/s0016-5085(99)70454-3.

DOI:10.1016/s0016-5085(99)70454-3

PMID:10464137

Abstract

BACKGROUND & AIMS: Liver transplantation for hepatitis C virus (HCV)-related liver disease is characterized by frequent graft infection by HCV. The prognosis and risk factors for morbidity and mortality in this condition were determined.

METHODS

A retrospective study of 652 consecutive anti-HCV-positive patients undergoing liver transplantation between 1984 and 1995 in 15 European centers was conducted; 102 patients coinfected with hepatitis B virus (HBV) received immunoglobulin prophylaxis for antibody to hepatitis B surface antigen.

RESULTS

Overall, 5-year survival was 72%. Five-year actuarial rates of hepatitis and cirrhosis were 80% and 10%. Genotypes 1b, 1a, and 2 were detected in 214 (80%), 24 (9%), and 24 (9%) of 268 patients analyzed. The only discriminant factor for patient or graft survival was hepatocellular carcinoma as primary indication. Independent risk factors for recurrent hepatitis included the absence of HBV coinfection before transplantation (relative risk [RR], 1.7; 95% confidence interval [CI], 1.2-2.6; P = 0.005), genotype 1b (RR, 2; 95% CI, 1.3-2.9; P = 0.01), and age > 49 years (RR, 1.4; 95% CI, 1.1-1.8; P = 0.01).

CONCLUSIONS

The results of transplantation for HCV-related disease are compromised by a significant risk of cirrhosis, although 5-year survival is satisfactory. Genotype 1b, age, and absence of pretransplantation coinfection by HBV are risk factors for recurrent HCV.

摘要

背景与目的

丙型肝炎病毒（HCV）相关肝病的肝移植特点是移植物频繁感染HCV。本研究确定了这种情况下的预后以及发病和死亡的危险因素。

方法

对1984年至1995年间在15个欧洲中心连续接受肝移植的652例抗HCV阳性患者进行回顾性研究；102例合并乙型肝炎病毒（HBV）感染的患者接受了乙肝表面抗原抗体免疫球蛋白预防治疗。

结果

总体而言，5年生存率为72%。肝炎和肝硬化的5年精算发生率分别为80%和10%。在268例分析患者中，214例（80%）、24例（9%）和24例（9%）检测到1b型、1a型和2型基因型。患者或移植物存活的唯一判别因素是以肝细胞癌作为主要指征。复发性肝炎的独立危险因素包括移植前无HBV合并感染（相对危险度[RR]，1.7；95%可信区间[CI]，1.2 - 2.6；P = 0.005）、1b型基因型（RR，2；95%CI，1.3 - 2.9；P = 0.01）以及年龄>49岁（RR，1.4；95%CI，1.1 - 1.8；P = 0.01）。