Huraib S, Iqbal A, Tanimu D, Abdullah A
Division of Nephrology, King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia.
Am J Nephrol. 2001 Nov-Dec;21(6):435-40. doi: 10.1159/000046646.
Patients who are anti-HCV positive before renal transplantation (Tx) have a significantly increased risk of posttransplant liver disease. We conducted a prospective, controlled study to evaluate the posttransplant outcome of renal graft candidates with HCV-associated chronic hepatitis (n = 30). Patients were randomly assigned to either of two groups. All patients on enrollment underwent liver biopsy, which showed mild-to-moderate hepatitis activity (mean 4.1, range 2-6). Half the patients received interferon-alpha (IFN-a) administered at a dosage of 3 million units three times weekly for 1 year. Liver biopsy was repeated for treated patients at the end of IFN-a treatment. Of these, 11 patients received renal transplant (group A). The other half did not receive IFN-a and to date 10 patients have been transplanted (group B). Renal transplant recipients were prospectively followed for a period of 12 months and a follow-up liver biopsy was also done at the end of this period (end of study). Biochemical and virological responses were evaluated and the histologic activity index (HAI) scoring according to Knodell was assessed. The mean pretreatment serum HCV RNA level was 1.14 +/- 0.84 and 1.0 +/- 0.89 mEq/ml for groups A and B, respectively (bDNA assay sensitivity threshold is <0.2 mEq/ml). HCV RNA became undetectable in 4 patients of group A. At the end of study period the mean quantitative HCV RNA titers were 1.43 +/- 4.07 and 15.18 +/- 11.08 mEq/ml in groups A and B, respectively (p < 0.0001). In group A, the mean HAI score decreased from 4.27 +/- 1.19 to 1.64 +/- 0.67 after IFN-a treatment (p < 0.0001). This score was maintained till the end of the study period with a mean of 1.82 +/- 0.6. Mean HAI score of group B on enrollment was 3.9 +/- 1.2 and at the end of study increased to 5.5 +/- 1.35 (p = 0.01). There was statistically significant difference (p value less than 0.0001) between the HAI scores at the end of the study period between the two groups. These results demonstrate that interferon therapy while on dialysis is associated with less viremia and decreased progression of chronic liver disease in renal transplant patients with hepatitis C.
肾移植（Tx）前抗丙型肝炎病毒（HCV）呈阳性的患者，移植后发生肝病的风险显著增加。我们进行了一项前瞻性对照研究，以评估丙型肝炎病毒相关慢性肝炎肾移植候选者（n = 30）移植后的结局。患者被随机分为两组。所有入选患者均接受肝活检，结果显示为轻度至中度肝炎活动（平均4.1，范围2 - 6）。一半患者接受α干扰素（IFN - a）治疗，剂量为每周3次，每次300万单位，持续1年。IFN - a治疗结束时，对接受治疗的患者再次进行肝活检。其中，11例患者接受了肾移植（A组）。另一半未接受IFN - a治疗，迄今为止有10例患者接受了移植（B组）。对肾移植受者进行了为期12个月的前瞻性随访，并在该时期结束时（研究结束时）也进行了随访肝活检。评估了生化和病毒学反应，并根据Knodell评估了组织学活动指数（HAI）评分。A组和B组治疗前血清HCV RNA平均水平分别为1.14±0.84和1.0±0.89 mEq/ml（分支DNA分析灵敏度阈值<0.2 mEq/ml）。A组4例患者的HCV RNA检测不到。在研究期结束时，A组和B组的HCV RNA定量平均滴度分别为1.43±4.07和15.18±11.08 mEq/ml（p < 0.0001）。在A组中，IFN - a治疗后HAI平均评分从4.27±1.19降至1.64±0.67（p < 0.0001）。该评分在研究期结束时一直维持，平均为1.82±0.6。B组入选时HAI平均评分为3.9±1.2，研究结束时升至5.5±1.35（p = 0.01）。两组研究期结束时的HAI评分之间存在统计学显著差异（p值小于0.
