Ricchiuti A, Brunati A, Mirabella S, Pierini A, Franchello A, Salizzoni M
Centro Trapianti di Fegato-Azienda Ospedaliera San Giovanni Battista di Torino, Turin, Italy.
Transplant Proc. 2005 Jul-Aug;37(6):2569-70. doi: 10.1016/j.transproceed.2005.06.004.
Our goal was to evaluate the outcome of HCV(+) recipients after liver transplantation (LT) using HCV(+) donors and the interaction between donor and recipient viral strain.
We performed a retrospective analysis of 21 LT performed between 1998 and 2004 using livers from HCV(+) donors in HCV(+) recipients. Two hundred thirty-seven patients with HCV cirrhosis who underwent LT with livers from HCV(-) donors were the control group. Ishak score (IS) was evaluated for all HCV(+) grafts. The considered variables included donor age, hepatic enzymes, intensive care unit stay, HCV genotype, ischemia time, recipient age, UNOS status, Child score, HCV genotype (before and 6 months after LT) and IS (after LT). We analyzed patient, graft, and disease-free survival.
HCV(+) donors were significantly older than HCV(-) donors. The cumulative 5-year patient and graft survivals and disease free intervals were not different between groups. IS grading was more than 2/18 in two cases; the only graft with a staging score over 2/6 was retransplanted for early nonfunction. In two cases, different HCV genotypes were matched and donor strain took over the recipient strain. In one patient, donor genotyping 2a-2c took over recipient genotyping 1b and 9 months after LT recurrent hepatitis was documented, but antiviral therapy cleared HCV.
Livers from HCV(+) donors can safely be used in HCV(+) recipients. Hepatic biopsy must always be performed; livers with bridging fibrosis should not be used. The takeover of one strain by another may change the prognosis of the patient if the predominant strain is more sensitive to antiviral therapy.
我们的目标是评估使用丙型肝炎病毒（HCV）阳性供体进行肝移植（LT）后HCV阳性受者的结局，以及供体和受者病毒株之间的相互作用。
我们对1998年至2004年间使用HCV阳性供体肝脏在HCV阳性受者中进行的21例肝移植进行了回顾性分析。237例接受HCV阴性供体肝脏肝移植的HCV肝硬化患者作为对照组。对所有HCV阳性移植物评估伊沙克评分（IS）。考虑的变量包括供体年龄、肝酶、重症监护病房停留时间、HCV基因型、缺血时间、受者年龄、美国器官共享联合网络（UNOS）状态、Child评分、HCV基因型（肝移植前和肝移植后6个月）以及IS（肝移植后）。我们分析了患者、移植物和无病生存率。
HCV阳性供体明显比HCV阴性供体年龄大。两组之间的5年累积患者和移植物生存率以及无病间隔没有差异。有两例IS分级超过2/18；唯一一例分期评分超过2/6的移植物因早期无功能而再次移植。有两例中，不同的HCV基因型匹配，供体毒株取代了受者毒株。在一名患者中，供体基因分型2a - 2c取代了受者基因分型1b，肝移植9个月后记录到复发性肝炎，但抗病毒治疗清除了HCV。
HCV阳性供体的肝脏可安全用于HCV阳性受者。必须始终进行肝活检；不应使用有桥接纤维化的肝脏。如果主要毒株对抗病毒治疗更敏感，一种毒株被另一种毒株取代可能会改变患者的预后。
