丙型肝炎复发患者肝移植后的纤维化进展

Fibrosis progression after liver transplantation in patients with recurrent hepatitis C.

作者信息

Neumann Ulf P, Berg Thomas, Bahra Marcus, Seehofer Daniel, Langrehr Jan M, Neuhaus Ruth, Radke Cornelia, Neuhaus Peter

机构信息

Klinik für Allgemein-, Viszeral-, und Transplantationschirurgie, Universitätsklinikum Charité, Campus Virchow-Klinikum, Humboldt-Universität zu Berlin, D-13353 Berlin, Germany.

出版信息

J Hepatol. 2004 Nov;41(5):830-6. doi: 10.1016/j.jhep.2004.06.029.

DOI:10.1016/j.jhep.2004.06.029

PMID:15519657

Abstract

BACKGROUND/AIMS: Aim of our study was to analyze fibrosis progression after liver transplantation (OLT) in hepatitis C virus (HCV)-infected patients based on protocol liver biopsies and to identify risk factors, which may play a role in the development of severe fibrosis stages.

METHODS

One hundred and eighty-three liver graft recipients who had a histological follow-up evaluation of 1 year after OLT were analyzed. Overall 1039 protocol liver biopsies were performed after 1-, 3-, 5-, 7- and 10 years and staged according to the Scheuer score.

RESULTS

The fibrosis progression rate was not linear. The fibrosis scores were 1.2 after one, 1.7 after three, 1.9 after five, 2.1 after 7 and 2.2 after 10 years. The 39 recipients with fibrosis stages 3 or 4 in the 1-year biopsy had a significantly reduced survival rate, while fibrosis stage 0-2 indicated excellent survival. Independent risk factors for progression of fibrosis at 1 year were HCV genotype 1 and 4 (P=0.01) and donor age>33 years (P=0.01), whereas risk factors for development of cirrhosis (30/183 recipients (16%)) were donor age (P=0.002) and multiple steroid pulses (P=0.05).

CONCLUSIONS

These data provide information on the course of recurrent hepatitis C and may be helpful to individualize the treatment of transplanted patients.

摘要

背景/目的：我们研究的目的是基于定期肝活检分析丙型肝炎病毒（HCV）感染患者肝移植（OLT）后的纤维化进展情况，并确定可能在严重纤维化阶段发展中起作用的危险因素。

方法

对183例肝移植受者进行分析，这些受者在OLT后进行了1年的组织学随访评估。在1年、3年、5年、7年和10年后共进行了1039次定期肝活检，并根据Scheuer评分进行分期。

结果

纤维化进展率并非呈线性。纤维化评分在1年后为1.2，3年后为1.7，5年后为1.9，7年后为2.1，10年后为2.2。在1年活检中纤维化分期为3或4期的39例受者生存率显著降低，而纤维化0 - 2期提示生存率良好。1年时纤维化进展的独立危险因素为HCV基因型1和4（P = 0.01）以及供体年龄>33岁（P = 0.01），而肝硬化发生（183例受者中有30例（16%））的危险因素为供体年龄（P = 0.002）和多次使用类固醇冲击治疗（P = 0.05）。