Khapra Asma Poonawala, Agarwal Kaushik, Fiel Maria Isabel, Kontorinis Nickolas, Hossain Sabera, Emre Sukru, Schiano Thomas D
Division of Liver Diseases, Department of Medicine, The Mount Sinai Medical Center, New York, NY 10029, USA.
Liver Transpl. 2006 Oct;12(10):1496-503. doi: 10.1002/lt.20849.
Studies have suggested that the use of hepatitis C virus (HCV)-positive (HCV+) donor allografts has no impact on survival. However, no studies have examined the effect that HCV+ donor histology has upon recipient and graft survival. We evaluated the clinical outcome and impact of histological features in HCV patients transplanted using HCV+ livers. We reviewed all patients transplanted for HCV at our institution from 1988 to 2004; 39 received HCV+ allografts and 580 received HCV-negative (HCV-) allografts. Survival curves compared graft and patient survival. Each HCV+ allograft was stringently matched to a control of HCV- graft recipients. No significant difference in survival was noted between recipients of HCV+ livers and controls. Patients receiving HCV+ allografts from older donors (age > or =50 yr) had higher rates of graft failure (hazard ratio, 2.74) and death rates (hazard ratio, 2.63) compared to HCV- allograft recipients receiving similarly-aged older donor livers. Matched case-control analysis revealed that recipients of HCV+ allografts had more severe fibrosis post-liver transplantation than recipients of HCV- livers (P = 0.008). More advanced fibrosis was observed in HCV+ grafts from older donors compared to HCV+ grafts from younger donors (P = 0.012). In conclusion, recipients of HCV+ grafts from older donors have higher rates of death and graft failure, and develop more extensive fibrosis than HCV- graft recipients from older donors. Recipients of HCV+ grafts, regardless of donor age, develop more advanced liver fibrosis than recipients of HCV- grafts.
研究表明，使用丙型肝炎病毒（HCV）阳性（HCV+）供体的同种异体移植物对生存率没有影响。然而，尚无研究探讨HCV+供体组织学对受体和移植物生存率的影响。我们评估了使用HCV+肝脏进行移植的HCV患者的临床结局和组织学特征的影响。我们回顾了1988年至2004年在我们机构接受HCV移植的所有患者；39例接受了HCV+同种异体移植物，580例接受了HCV阴性（HCV-）同种异体移植物。生存曲线比较了移植物和患者的生存率。每个HCV+同种异体移植物都与HCV-移植物受体的对照进行了严格匹配。HCV+肝脏受体与对照组之间的生存率没有显著差异。与接受年龄相仿的老年供体肝脏的HCV-同种异体移植物受体相比，接受老年供体（年龄≥50岁）HCV+同种异体移植物的患者移植失败率（风险比，2.74）和死亡率（风险比，2.63）更高。配对病例对照分析显示，HCV+同种异体移植物受体在肝移植后比HCV-肝脏受体有更严重的纤维化（P = 0.008）。与来自年轻供体的HCV+移植物相比，来自老年供体的HCV+移植物中观察到更严重的纤维化（P = 0.012）。总之，来自老年供体的HCV+移植物受体的死亡率和移植失败率更高，并且比来自老年供体的HCV-移植物受体发展出更广泛的纤维化。无论供体年龄如何，HCV+移植物受体比HCV-移植物受体发展出更严重的肝纤维化。
