Lee W C, Shu K H, Cheng C H, Wu M J, Chen C H, Lian J C
Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.
Am J Nephrol. 2001 Jul-Aug;21(4):300-6. doi: 10.1159/000046265.
Chronic liver disease and its complications are major problems in renal transplant recipients. Our aim was to elucidate the influence of hepatitis B, C virus infection on the long-term outcome of renal transplantation. Four hundred and seventy-seven patients who received renal transplantation between January 1984 and December 1999, and who were followed up at our hospital were enrolled. HBsAg was detected by the RIA method and anti-HCV Ab was assayed by the second-generation RIA kit. SGOT/ SGPT were checked every 3 months. Hepatoma was diagnosed by dynamic CT scan, elevated alpha-fetoprotein, hypervascularity by angiography and confirmed by pathological examination. The prevalence of HBV, HCV, coinfected HBV/HCV was 9.9% (n = 47), 28.5% ( n = 136), 3.1% (n = 15), respectively. The incidences of hepatoma in the HBV-/HCV-, HBV-/HCV+, HBV+/HCV-, HBV+/HCV+ groups were 1.4% (n = 4), 4.4% (n = 6), 6.4% (n = 3), 6.7% (n = 1), respectively (p = 0.114). The incidences of liver cirrhosis/hepatic failure were 3.2% (n = 9), 6.6% (n = 9), 21.3% (n = 10), 20% (n = 3), respectively (p < 0.001). The frequencies of chronic liver disease were 10.4% (n = 29), 45.6% (n = 62), 66% (n = 31), 80% (n = 12), respectively (p < 0.001). Patient and graft survival rates were lower in the HBV-infected group than in the other groups. Cox regression analysis revealed that HBV infection is likely an independent risk factor for patient mortality although the statistical significance was only borderline. Patients with HBV as well as HCV infection were not at risk of graft loss according to this model of analysis. Patients with HBV infection showed higher incidences of hepatoma, hepatic failure, graft failure and death. Therefore, HBV-infected patients who are candidates for renal transplantation should be carefully evaluated. It seems that HCV infection has little influence on the outcome of renal transplant recipients. A longer period of follow-up is needed to clarify the impact of HCV on renal transplant recipients.
慢性肝病及其并发症是肾移植受者面临的主要问题。我们的目的是阐明乙型、丙型肝炎病毒感染对肾移植长期预后的影响。纳入了1984年1月至1999年12月期间在我院接受肾移植并接受随访的477例患者。采用放射免疫分析法检测HBsAg，用第二代放射免疫分析试剂盒检测抗-HCV抗体。每3个月检查一次谷草转氨酶/谷丙转氨酶。通过动态CT扫描、甲胎蛋白升高、血管造影显示血管增多并经病理检查确诊肝癌。HBV、HCV、HBV/HCV合并感染的患病率分别为9.9%（n = 47）、28.5%（n = 136）、3.1%（n = 15）。HBV-/HCV-、HBV-/HCV+、HBV+/HCV-、HBV+/HCV+组的肝癌发生率分别为1.4%（n = 4）、4.4%（n = 6）、6.4%（n = 3）、6.7%（n = 1）（p = 0.114）。肝硬化/肝衰竭的发生率分别为3.2%（n = 9）、6.6%（n = 9）、21.3%（n = 10）、20%（n = 3）（p < 0.001）。慢性肝病的发生率分别为10.4%（n = 29）、45.6%（n = 62）、66%（n = 31）、80%（n = 12）（p < 0.001）。HBV感染组的患者和移植物存活率低于其他组。Cox回归分析显示，HBV感染可能是患者死亡的独立危险因素，尽管统计学意义仅处于临界水平。根据该分析模型，HBV和HCV感染的患者没有移植物丢失风险。HBV感染患者的肝癌、肝衰竭、移植物衰竭和死亡发生率较高。因此，对于肾移植候选的HBV感染患者应进行仔细评估。丙型肝炎病毒感染似乎对肾移植受者的预后影响较小。需要更长时间的随访来阐明HCV对肾移植受者的影响。
