Batty D S, Swanson S J, Kirk A D, Ko C W, Agodoa L Y, Abbott K C
Organ Transplantation Service, Walter Reed Army Medical Center, National Institutes of Health, Bethesda, MD, USA.
Am J Transplant. 2001 Jul;1(2):179-84.
National statistics for patient characteristics and survival of renal transplant recipients positive for hepatitis C virus (HCV+) at the time of renal transplant are presented. A historical cohort analysis of 33479 renal transplant recipients in the United States Renal Data System from 1 July, 1994 to 30 June, 1997 has been carried out. The medical evidence form was also used for additional variables, but because of fewer available values, this was analyzed in a separate model. Outcomes were patient characteristics and survival associated with HCV+. Of 28692 recipients with valid HCV serologies, 1624 were HCV+ at transplant (5.7% prevalence). In logistic regression analysis, HCV+ was associated with African-American race, male gender, cadaveric donor type, increased duration of pre-transplant dialysis, previous transplant, donor HCV+, recipient (but not donor) age, serum albumin, alcohol use, and increased all-cause hospitalizations. Diabetes and IgA nephropathy were less associated with HCV+. Total all-cause, unadjusted mortality was 13.1% in HCV+ vs. 8.5% in HCV- patients (p <0.01 by log rank test). In Cox regression, mortality was higher for HCV+ (adjusted hazard ratio = 1.23, 95% confidence interval = 1.01-1.49, p = 0.04). HCV+ recipients were more likely to be African-American, male, older, and to have received repeat transplants and donor HCV+ transplants. HCV+ recipients also had substantially longer waiting times for transplant. In contrast to recent studies, diabetes did not have an increased association with HCV+, perhaps due to limitations of the database. HCV+ recipients had increased mortality and hospitalization rates compared with other transplant recipients.
本文呈现了肾移植时丙型肝炎病毒呈阳性（HCV+）的肾移植受者的患者特征及生存情况的全国统计数据。对1994年7月1日至1997年6月30日期间美国肾脏数据系统中的33479例肾移植受者进行了一项历史性队列分析。医学证据表还用于其他变量，但由于可用值较少，在单独的模型中进行了分析。研究结果为与HCV+相关的患者特征及生存情况。在28692例HCV血清学检测有效的受者中，1624例在移植时为HCV+（患病率为5.7%）。在逻辑回归分析中，HCV+与非裔美国人种族、男性、尸体供体类型、移植前透析时间延长、既往移植、供体HCV+、受者（而非供体）年龄、血清白蛋白、饮酒以及全因住院次数增加有关。糖尿病和IgA肾病与HCV+的关联较小。HCV+患者的全因未调整死亡率为13.1%，而HCV-患者为8.5%（对数秩检验p<0.01）。在Cox回归中，HCV+患者的死亡率更高（调整后的风险比=1.23，95%置信区间=1.01-1.49，p=0.04）。HCV+受者更可能是非裔美国人、男性、年龄较大，并且接受过再次移植和供体HCV+移植。HCV+受者移植等待时间也显著更长。与近期研究不同的是，糖尿病与HCV+的关联并未增加，这可能是由于数据库的局限性。与其他移植受者相比，HCV+受者的死亡率和住院率更高。
