Asfandiyar S, Abouljoud M, Kim D, Brown K, Yoshida A, Arenas J, Sherbondy M, Divine G, Moonka D
Department of Gastroenterology, Henry Ford Health Systems, Detroit, Michigan 48202, USA.
Transplant Proc. 2006 Dec;38(10):3643-5. doi: 10.1016/j.transproceed.2006.10.166.
Liver transplantation (OLT) is often complicated by renal failure. Hepatitis C (HCV) is said to be a risk factor for renal failure after OLT, but few studies have analyzed this directly. We evaluated all patients who received a liver transplant from 1995 through 2003. There were 147 patients infected with HCV and 202 not infected. Patients with HCV were further divided into 114 patients with benign HCV and 33 patients with severe HCV defined by bridging fibrosis or cirrhosis. The groups were evaluated for the development of renal insufficiency defined as a creatinine above 1.8 mg/dL on three consecutive occasions or renal failure as defined by the need for dialysis or renal transplant. The incidence of renal failure in patients with HCV was 10.2% and in patients without HCV was 3.5% (P = .004). Patients with severe HCV had an incidence of 12.1% vs 9.7% for patients with mild HCV. The linear trend in renal failure from non-HCV to mild HCV to severe HCV was significant (P = .012). The incidence of renal insufficiency was 23.4% in patients with HCV and 14.9% in patients without HCV (P = .080). The incidence was 32.3% in patients with severe HCV and 20.6% in patients with mild HCV. The trend in renal insufficiency across the three groups was mildly significant (P = .042). On multivariate analysis, HCV was a risk factor for renal failure with a relative risk of 2.58 (P = .045). The study suggests that HCV and the severity of recurrent HCV are risk factors for renal dysfunction after liver transplantation.
肝移植（OLT）常并发肾衰竭。丙型肝炎病毒（HCV）被认为是OLT术后肾衰竭的一个危险因素，但很少有研究直接对此进行分析。我们评估了1995年至2003年期间所有接受肝移植的患者。其中147例患者感染了HCV，202例未感染。感染HCV的患者进一步分为114例良性HCV患者和33例由桥接纤维化或肝硬化定义的严重HCV患者。对这些组进行评估，以确定是否发生肾功能不全（定义为连续三次肌酐水平高于1.8mg/dL）或肾衰竭（定义为需要透析或肾移植）。HCV感染患者的肾衰竭发生率为10.2%，未感染HCV的患者为3.5%（P = 0.004）。严重HCV患者的发生率为12.1%，而轻度HCV患者为9.7%。从非HCV到轻度HCV再到严重HCV，肾衰竭的线性趋势具有统计学意义（P = 0.012）。HCV感染患者的肾功能不全发生率为23.4%，未感染HCV的患者为14.9%（P = 0.080）。严重HCV患者的发生率为32.3%，轻度HCV患者为20.6%。三组间肾功能不全的趋势具有轻度统计学意义（P = 0.042）。多因素分析显示，HCV是肾衰竭的危险因素，相对风险为2.58（P = 0.045）。该研究表明，HCV及其复发的严重程度是肝移植术后肾功能障碍的危险因素。
