丙型肝炎感染相关肝病：成人尸体供肝和活体供肝肝移植后的复发模式及结局

Hepatitis C infection-related liver disease: patterns of recurrence and outcome in cadaveric and living-donor liver transplantation in adults.

作者信息

Van Vlierberghe H, Troisi R, Colle I, Ricciardi S, Praet M, de Hemptinne B

机构信息

Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium.

出版信息

Transplantation. 2004 Jan 27;77(2):210-4. doi: 10.1097/01.TP.0000101007.59478.8B.

DOI:10.1097/01.TP.0000101007.59478.8B

Abstract

BACKGROUND

Preliminary data demonstrate that the recurrence of hepatitis C is more severe in patients undergoing adult-to-adult living liver (AAL) transplantation (Tx) in comparison with cadaveric liver (CL) Tx. The authors report on the 1-year follow-up of their cohort of hepatitis C virus (HCV) patients undergoing AALTx or CLTx.

METHODS

Twenty-six patients with HCV end-stage liver cirrhosis underwent CLTx and 17 underwent AALTx. The diagnosis of recurrent HCV was made on the basis of increased transaminases, detectable HCV RNA levels, and histologic findings on liver biopsy. Liver biopsies were performed on the basis of clinical indications. Bilirubin concentration, partial thromboplastin time, and alanine aminotransferase activity were compared between the two groups at different time intervals.

RESULTS

HCV recurrence was seen in 10 of 26 CLTx patients versus 6 of 17 AALTx patients (P=0.1). Time until recurrence was longer in AALTx patients (158+/-114 days vs. 227+/-154 days, P=0.4). Of the biochemical parameters, only bilirubin concentration at week 4 was significantly different between AALTx and CLTx patients (3.1+/-4.3 mg/dL vs. 1.26+/-0.83 mg/dL, P=0.04). Overall survival and the number of patients needing retransplantation were similar in both groups.

CONCLUSIONS

At a follow-up period of 1 year, there is no difference in outcome between end-stage HCV patients undergoing AALTx or CLTx.

摘要

背景

初步数据表明，与尸体肝移植（CLTx）相比，接受成人对成人活体肝（AAL）移植的丙型肝炎患者丙型肝炎复发更为严重。作者报告了他们对接受AALTx或CLTx的丙型肝炎病毒（HCV）患者队列的1年随访情况。

方法

26例HCV终末期肝硬化患者接受了CLTx，17例接受了AALTx。复发性HCV的诊断基于转氨酶升高、可检测到的HCV RNA水平以及肝活检的组织学结果。根据临床指征进行肝活检。比较两组在不同时间间隔的胆红素浓度、部分凝血活酶时间和丙氨酸转氨酶活性。

结果

26例CLTx患者中有10例出现HCV复发，而17例AALTx患者中有6例出现复发（P=0.1）。AALTx患者复发的时间更长（158±114天对227±154天，P=0.4）。在生化参数中，仅第4周时AALTx和CLTx患者的胆红素浓度有显著差异（3.1±4.3mg/dL对1.26±0.83mg/dL，P=0.04）。两组的总生存率和需要再次移植的患者数量相似。

结论

在1年的随访期内，接受AALTx或CLTx的终末期HCV患者的结局没有差异。