Sreekumar R, Gonzalez-Koch A, Maor-Kendler Y, Batts K, Moreno-Luna L, Poterucha J, Burgart L, Wiesner R, Kremers W, Rosen C, Charlton M R
Mayo Clinic and Foundation, Rochester, MN, USA.
Hepatology. 2000 Nov;32(5):1125-30. doi: 10.1053/jhep.2000.19340.
Approximately half of patients undergoing liver transplantation (LT) for hepatitis C virus (HCV) develop histologic evidence of recurrence within the first postoperative year. Early identification of recipients at risk for more severe recurrence of HCV may be useful in selecting patients for antiviral therapy. We determined whether recipients at greatest risk for more severe recurrence of HCV can be identified by pre- and/or early post-LT HCV-RNA levels in serum or tissue. Serum and tissue samples were prospectively collected pre-LT and at 7 days, 4 months, 1 year, and at 3 years posttransplantation from patients undergoing LT for HCV. Hepatitis activity index (HAI) and fibrosis stage (FS) were assessed in all liver biopsies. Forty-seven patients (32 men) were studied. Higher HCV-RNA levels at 4 months post-LT (>/=10(9) copies/mL, n = 29) were associated with higher HAI at 1 year and at 3 years post-LT. The HAI seen on protocol biopsies at 4 months correlated significantly with fibrosis stage (FS) at 1 year (r =.56, P </=.001) and 3 years (r =. 53, P =.002). Higher HCV-RNA levels at 7 days and 4 months post-LT were sensitive (66% and 84%, respectively) and specific (92% and 63%, respectively) in identifying recipients with an HAI greater than 3 at 3 years. Higher pre- and early post-LT HCV-RNA levels are associated with more severe recurrence of HCV. The correlation of early HAI with subsequent FS suggests that higher mean HAI will eventually translate into more advanced stages of fibrosis. Patients at risk for more severe post-LT recurrence of HCV can be identified by early posttransplant HCV-RNA levels.
因丙型肝炎病毒（HCV）接受肝移植（LT）的患者中，约有一半在术后第一年出现复发的组织学证据。早期识别有更严重HCV复发风险的受者，可能有助于选择接受抗病毒治疗的患者。我们确定是否可以通过LT前和/或LT后早期血清或组织中的HCV-RNA水平，来识别有更严重HCV复发风险的受者。前瞻性收集了因HCV接受LT患者LT前以及移植后7天、4个月、1年和3年的血清和组织样本。对所有肝活检组织评估肝炎活动指数（HAI）和纤维化分期（FS）。共研究了47例患者（32例男性）。LT后4个月时较高的HCV-RNA水平（>/=10⁹拷贝/mL，n = 29）与LT后1年和3年时较高的HAI相关。4个月时按方案进行活检时观察到的HAI与1年（r = 0.56，P≤0.001）和3年（r = 0.53，P = 0.002）时的纤维化分期（FS）显著相关。LT后7天和4个月时较高的HCV-RNA水平在识别3年时HAI大于3的受者方面具有敏感性（分别为66%和84%）和特异性（分别为92%和63%）。LT前和LT后早期较高的HCV-RNA水平与更严重的HCV复发相关。早期HAI与后续FS的相关性表明，较高的平均HAI最终将转化为更晚期的纤维化阶段。LT后有更严重HCV复发风险的患者可通过移植后早期HCV-RNA水平来识别。
