Huo T I, Yang W C, Wu J C, King K L, Loong C C, Lin C Y, Lui W Y, Chang F Y, Lee S D
Department of Medicine, Taipei Veterans General Hospital, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 2000 Feb;63(2):93-100.
There has been improvement in kidney transplantation over the years; however, the impact of hepatitis B and C virus (HBV, HCV) infection on the long-term outcome of kidney transplant is still controversial.
A total of 113 patients who received renal allografts from 1986 to 1998 were analyzed. Nine were positive for both hepatitis B surface antigen (HBsAg) and antibody to HCV (anti-HCV) (Group 1), 20 were HBsAg-positive and anti-HCV-negative (Group 2), 30 were HBsAg-negative and anti-HCV-positive (Group 3) and 54 were negative for both markers (Group 4). The outcome and survival were compared among the four groups of patients.
The mean follow-up period was 5.1 +/- 3.2 years (range, 0.5-13 years) for all patients. Group 2 patients had significantly higher liver-related complications (35% vs 0%, p < 0.0001) and liver-related deaths (20% vs 0%, p = 0.004) than did Group 4 patients. Among all, four HBsAg-positive patients had fulminant hepatitis and died within two years of transplantation. Three (Group 2) of the patients who died were seropositive for hepatitis B e antigen and/or HBV DNA and none had a history of or positive serologic marker to indicate hepatitis of other etiologies. The remaining patient (Group 1) had evidence of superinfection of HCV. Liver cirrhosis occurred in one, two and one patient in Groups 1, 2 and 3, respectively, and hepatocellular carcinoma occurred in two and one patient in Groups 2 and 3, respectively. Despite high liver-related mortality in HBV-infected patients, paradoxically, no significant differences among the four groups in the long-term graft and patient survivals were demonstrated. The presence of HBsAg or anti-HCV was not associated with a poor prognosis of survival as determined by Cox regression analysis.
HBV or HCV infection is not a contraindication to kidney transplantation in Chinese patients. However, it should be noted that serious liver-related complications may occur and limit survival in HBV- and/or HCV-infected patients after kidney transplantation.
多年来肾移植情况已有改善；然而，乙型和丙型肝炎病毒（HBV、HCV）感染对肾移植长期预后的影响仍存在争议。
分析了1986年至1998年期间接受同种异体肾移植的113例患者。9例患者乙肝表面抗原（HBsAg）和抗HCV抗体均呈阳性（第1组），20例患者HBsAg阳性且抗HCV阴性（第2组），30例患者HBsAg阴性且抗HCV阳性（第3组），54例患者两种标志物均为阴性（第4组）。比较了四组患者的预后和生存率。
所有患者的平均随访期为5.1±3.2年（范围0.5 - 13年）。第2组患者的肝脏相关并发症（35%对0%，p < 0.0001）和肝脏相关死亡（20%对0%，p = 0.004）显著高于第4组患者。其中，4例HBsAg阳性患者发生暴发性肝炎并在移植后两年内死亡。死亡的患者中有3例（第2组）乙肝e抗原和/或HBV DNA血清学阳性，且均无其他病因肝炎的病史或阳性血清学标志物。其余患者（第1组）有HCV重叠感染的证据。第1、2和3组分别有1例、2例和1例患者发生肝硬化，第2和3组分别有2例和1例患者发生肝细胞癌。尽管HBV感染患者肝脏相关死亡率较高，但矛盾的是，四组患者的长期移植物和患者生存率并无显著差异。Cox回归分析显示，HBsAg或抗HCV的存在与生存预后不良无关。
HBV或HCV感染并非中国患者肾移植的禁忌证。然而，应注意的是，肾移植后HBV和/或HCV感染患者可能会发生严重的肝脏相关并发症并影响生存。
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