Neumann Ulf P, Berg Thomas, Bahra Marcus, Puhl Gero, Guckelberger Olaf, Langrehr Jan M, Neuhaus Peter
Klinik für Allgemein-, Viszeral-, und Transplantationschirurgie, Universitätsklinikum Charité, Campus Virchow-Klinikum, Humboldt-Universität, Berlin, Germany.
Transplantation. 2004 Jan 27;77(2):226-31. doi: 10.1097/01.TP.0000101738.27552.9D.
Recurrence of hepatitis C (HCV) infection after orthotopic liver transplantation (OLT) in HCV-positive patients is almost universal. Severity of graft hepatitis increases during the long-term follow-up, and up to 30% of patients develop severe graft hepatitis and cirrhosis. However, there are still no clear predictors for severe recurrence. The aim of this study was to examine the 10-year outcome and risk factors for graft failure caused by HCV recurrence.
In a prospective analysis, 234 OLTs in 209 HCV-positive patients with a median age of 53 years were analyzed. Immunosuppression was based on cyclosporine A or tacrolimus in different protocols. Predictors for outcome were genotype, viremia, donor variables, recipient demographics, postoperative immunosuppression, and human leukocyte antigen (HLA) compatibilities.
Actuarial 5-, and 10-year patient survival was 75.8% and 68.8%. Eighteen of 209 (8.7%) patients died because of HCV recurrence, which was responsible for 35.9% of the total 53 deaths. Significant risk factors for HCV-related graft failure in an univariate analysis were multiple steroid pulses, use of OKT3, and donor age greater than 40. However, in a multivariate analysis, multiple rejection treatments with steroids and OKT3 treatment proved to be significantly associated with HCV-related graft loss.
The analysis of causes leading to graft failure in patients with HCV showed that HCV recurrence is responsible for one of three deaths in HCV-positive patients. Rejection treatment contributed significantly to an enhanced risk for HCV-related graft loss. New antiviral treatments, as well as adapted immunosuppressive protocols, will be necessary to further improve the outcome of HCV-positive patients after liver transplantation.
丙型肝炎病毒（HCV）阳性患者原位肝移植（OLT）后丙型肝炎感染复发几乎是普遍现象。在长期随访中，移植肝肝炎的严重程度会增加，高达30%的患者会发展为严重的移植肝肝炎和肝硬化。然而，目前仍没有明确的严重复发预测指标。本研究的目的是探讨HCV复发导致移植失败的10年结局及危险因素。
在一项前瞻性分析中，对209例HCV阳性患者的234例OLT进行了分析，患者中位年龄为53岁。免疫抑制采用不同方案的环孢素A或他克莫司。结局的预测指标包括基因型、病毒血症、供体变量、受体人口统计学特征、术后免疫抑制以及人类白细胞抗原（HLA）相容性。
5年和10年的精算患者生存率分别为75.8%和68.8%。209例患者中有18例（8.7%）因HCV复发死亡，占53例总死亡人数的35.9%。单因素分析中，与HCV相关移植失败的显著危险因素包括多次使用类固醇冲击治疗、使用OKT3以及供体年龄大于40岁。然而，多因素分析显示，多次使用类固醇进行抗排斥治疗和OKT3治疗与HCV相关的移植肝丢失显著相关。
对HCV患者移植失败原因的分析表明，HCV复发是HCV阳性患者三分之一死亡的原因之一。抗排斥治疗显著增加了HCV相关移植肝丢失的风险。为进一步改善HCV阳性患者肝移植后的结局，需要新的抗病毒治疗以及调整免疫抑制方案。
