Sugo Hiroyuki, Balderson Glenda A, Crawford Darrell H G, Fawcett Jonathan, Lynch Stephen V, Strong Russell W, Futagawa Shunji
The Queensland Liver Transplant Service, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Qld 4102, Australia.
Surg Today. 2003;33(6):421-5. doi: 10.1007/s10595-002-2537-5.
The aim of this study was to report the influence of hepatitis C virus (HCV) genotype and rejection episodes on the outcome of orthotopic liver transplantation (OLT), hepatitis recurrence, and progression to graft cirrhosis after OLT.
Fifty-three patients who all had undergone OLT for end-stage liver cirrhosis were selected for this study. Hepatitis C genotype was determined. Recurrent hepatitis and rejection were diagnosed based on elevated liver function tests and a liver biopsy.
The patients were followed up for a mean of 51.9 +/- 34.3 months. The cumulative survival rate was no different in OLT for hepatitis C and OLT for all other liver diseases. After OLT, serum HCV RNA was detected in 93%. Histological recurrence occurred in 85% of all patients. The 1-, 3-, and 5-year recurrence rates were 48%, 77%, and 85%, respectively. Of the 41 patients with recurrent hepatitis C, 4 (10%) had cirrhosis, 18 (44%) had hepatitis with fibrosis, and 91 (46%) had hepatitis without fibrosis at the end of follow-up. A total of 32% of the patients were infected by HCV genotype 1b and 68% by other HCV genotypes. The recurrence rates were significantly higher in patients infected with genotype 1b than in those with other genotypes ( p = 0.04). Twenty of 48 patients (42%) experienced acute rejection. There was a strong association between the number of rejection episodes and the incidence of HCV-related cirrhosis ( p < 0.01).
Our findings showed the genotype 1b to result in a higher recurrence rate after OLT. On the other hand, rejection episodes were associated with a more rapid progression to graft cirrhosis.
本研究旨在报告丙型肝炎病毒（HCV）基因型和排斥反应对原位肝移植（OLT）结局、肝炎复发以及OLT后移植物肝硬化进展的影响。
本研究选取了53例均因终末期肝硬化接受OLT的患者。确定丙型肝炎基因型。根据肝功能检查结果升高和肝活检诊断复发性肝炎和排斥反应。
患者平均随访51.9±34.3个月。丙型肝炎OLT和所有其他肝病OLT的累积生存率无差异。OLT后，93%的患者检测到血清HCV RNA。85%的患者发生组织学复发。1年、3年和5年复发率分别为48%、77%和85%。在41例复发性丙型肝炎患者中，4例（10%）有肝硬化，18例（44%）有纤维化性肝炎，91例（46%）在随访结束时有无纤维化性肝炎。共有32%的患者感染HCV 1b基因型，68%感染其他HCV基因型。感染1b基因型的患者复发率显著高于其他基因型患者（p = 0.04）。48例患者中有20例（42%）发生急性排斥反应。排斥反应次数与HCV相关肝硬化的发生率之间存在密切关联（p < 0.01）。
我们的研究结果表明，1b基因型导致OLT后复发率更高。另一方面，排斥反应与移植物肝硬化进展更快有关。
