Brillanti Stefano, Vivarelli Marco, De Ruvo Nicola, Aden Ardo Abdiueli, Camaggi Valeria, D'Errico Antonia, Furlini Giuliano, Bellusci Roberto, Roda Enrico, Cavallari Antonino
Department of Internal Medicine and Gastroenterology, University of Bologna, Italy.
Liver Transpl. 2002 Oct;8(10):884-8. doi: 10.1053/jlts.2002.34640.
Chronic hepatitis C represents a major clinical problem after liver transplantation, but factors influencing the recurrent disease have not been well characterized. We analyzed the clinical records of all the patients transplanted for hepatitis C virus (HCV)-related liver disease in our Center between 1991 and 1997. Eighty consecutive HCV-positive (+) patients (60 men, ages 28 to 64) survived more than 1 month after transplantation and were followed for a median of 45 months. Diagnosis of recurrent chronic hepatitis C was made in 38 patients (47.5%), of whom 22 had moderate/severe chronic hepatitis. Decompensated cirrhosis occurred in six patients (7.5%). No difference in patient survival was found between patients with and without hepatitis C recurrence. No association was found between recurrent hepatitis C and presumed risk factors. The method of tapering off corticosteroids was significantly associated with both hepatitis C recurrence and the severity of hepatitis. In patients receiving a higher daily prednisone dose, 12 months after transplantation, the proportion of recurrent hepatitis C was 35.7% versus 66.6% (P = .02; odds ratio [OR], 3.6; 95% confidence interval (CI): 1.25 to 10.36), and among patients receiving a higher daily prednisone dose, 6 months after transplantation, the proportion of moderate/severe chronic hepatitis C was 40% versus 89% (P = .03; OR: 0.08, 95% CI: 0.008 to 0.84). Finally, prednisone dose at month six was significantly associated with disease-free survival of the liver graft. In conclusion, our results seem to indicate that in HCV-infected liver transplant recipients, a long-term treatment with corticosteroids, slowly tapered off over time, may prevent the more aggressive forms of recurrent liver disease.
慢性丙型肝炎是肝移植后一个主要的临床问题，但影响疾病复发的因素尚未得到充分阐明。我们分析了1991年至1997年间在本中心因丙型肝炎病毒（HCV）相关肝病接受移植的所有患者的临床记录。连续80例HCV阳性（+）患者（60例男性，年龄28至64岁）移植后存活超过1个月，中位随访45个月。38例患者（47.5%）诊断为复发性慢性丙型肝炎，其中22例为中度/重度慢性肝炎。6例患者（7.5%）发生失代偿性肝硬化。丙型肝炎复发患者与未复发患者的生存率无差异。复发性丙型肝炎与假定的危险因素之间未发现关联。逐渐减少皮质类固醇的方法与丙型肝炎复发及肝炎严重程度均显著相关。在移植后12个月接受较高每日泼尼松剂量的患者中，丙型肝炎复发率为35.7%，而在接受较低每日泼尼松剂量的患者中为66.6%（P = 0.02；优势比[OR]，3.6；95%置信区间[CI]：1.25至10.36），在移植后6个月接受较高每日泼尼松剂量的患者中，中度/重度慢性丙型肝炎的比例为40%，而在接受较低每日泼尼松剂量的患者中为89%（P = 0.03；OR：0.08，95%CI：0.008至0.84）。最后，移植后6个月时的泼尼松剂量与肝移植的无病生存率显著相关。总之，我们的结果似乎表明，在HCV感染的肝移植受者中，长期使用皮质类固醇并随时间逐渐缓慢减量，可能预防更具侵袭性的复发性肝病形式。
