Mahmoud Ihab M, Elhabashi Ahmed F, Elsawy Esam, El-Husseini Amr A, Sheha Gamal E, Sobh Mohamed A
Nephrology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Am J Kidney Dis. 2004 Jan;43(1):131-9. doi: 10.1053/j.ajkd.2003.09.018.
The impact of hepatitis C virus (HCV) infection on long-term patient and renal graft survival is controversial.
We prospectively followed up for approximately 9 years 133 hepatitis B surface antigen (HBsAg)-negative successive renal transplant recipients for whom HCV RNA polymerase chain reaction (PCR) results were available before transplantation. We compared graft and patient survival rates and causes of death and graft failure in PCR-positive and PCR-negative transplant recipients. Cox proportional hazards models were used to detect the impact of HCV infection on patient and graft survival. We also studied posttransplantation hepatic function and graft performance.
HCV RNA was detected in sera of 87 patients (65%). Univariate and multivariate analyses did not show an increased risk for death or graft failure in viremic compared with nonviremic transplant recipients. However, HCV-infected transplant recipients with chronic alanine aminotransferase level elevations had increased risks for death (odds ratio, 3.7; 95% confidence interval [CI], 1 to 13.7) and graft failure (odds ratio, 3; 95% CI, 1.4 to 6.7) compared with viremic transplant recipients with persistently normal liver function test results and noninfected patients. Five viremic and no nonviremic transplant recipients died of liver disease. HCV viremic transplant recipients had significantly greater frequencies of biochemical chronic liver disease, proteinuria, and biopsy-proven chronic allograft nephropathy (CAN) compared with noninfected transplant recipients.
HCV infection per se has no adverse effect on long-term renal graft and patient survival. However, HCV-infected transplant recipients with abnormal liver function have inferior survival rates. HCV infection in renal transplants is associated with greater rates of proteinuria and CAN.
丙型肝炎病毒（HCV）感染对患者长期生存及肾移植存活的影响存在争议。
我们对133例连续的肾移植受者进行了约9年的前瞻性随访，这些受者乙肝表面抗原（HBsAg）阴性，且移植前可获得HCV RNA聚合酶链反应（PCR）结果。我们比较了PCR阳性和PCR阴性移植受者的移植存活率、患者存活率、死亡原因及移植失败原因。采用Cox比例风险模型检测HCV感染对患者及移植存活的影响。我们还研究了移植后的肝功能及移植表现。
87例患者（65%）血清中检测到HCV RNA。单因素和多因素分析均未显示病毒血症移植受者相比于非病毒血症移植受者死亡或移植失败风险增加。然而，与肝功能试验结果持续正常的病毒血症移植受者及未感染患者相比，丙氨酸氨基转移酶水平慢性升高的HCV感染移植受者死亡风险增加（比值比，3.7；95%置信区间[CI]，1至13.7），移植失败风险增加（比值比，3；95%CI，1.4至6.7）。5例病毒血症移植受者而非非病毒血症移植受者死于肝病。与未感染移植受者相比，HCV病毒血症移植受者生化性慢性肝病、蛋白尿及活检证实的慢性移植肾肾病（CAN）的发生率显著更高。
HCV感染本身对肾移植长期存活及患者生存无不良影响。然而，肝功能异常的HCV感染移植受者生存率较低。肾移植中的HCV感染与更高的蛋白尿及CAN发生率相关。
