Kliem V, Burg M, Haller H, Suwelack B, Abendroth D, Fritsche L, Fornara P, Pietruck F, Frei U, Donauer J, Lison A E, Michel U
Department of Internal Medicine/Nephrology, Nephrological Center, Hann. Muenden, Germany.
Transplant Proc. 2008 May;40(4):909-14. doi: 10.1016/j.transproceed.2008.03.031.
Chronic liver disease resulting from hepatitis B (HBV) and hepatitis C (HCV) virus infections is still a major concern in kidney recipients. Our aim was to evaluate the prevalences, risk factors, and impact of HBV and HCV infections in adult renal transplant recipients in Germany.
Data were collected on 1633 kidney recipients transplanted between 1989 and 2002 at the 21 German renal transplant centers participating in MOST, the prospective Multinational Observational Study in Transplantation. Subgroup analyses compared HBV- and HCV-positive patients vs those with HBV/HCV-negative serology at the time of transplantation.
The prevalences of 4.4% (n = 72) for HBV and 5.8% (n = 94) for HCV showed a marked decline over the last 15 years. Retransplantations were significantly more common among HBV+ (29%) and HCV+ (36%) than HBV-/HCV- patients (12%). HCV+ patients experienced significantly longer dialysis times and received significantly more pretransplantation blood transfusions. Between all groups, no significant differences were observed in acute rejection rate at 12 months or in renal graft function up to 5 years posttransplantation (mean glomerular filtration rate: HBV+, 57.3 mL/min; HCV+, 58.5 mL/min; HBV-/HCV-, 59 mL/min). No progressive elevations in liver enzymes and bilirubin were noted during the 5-year observation period.
HBV and HCV infections currently have a low prevalence among German kidney graft recipients. Long dialysis times, blood transfusions, and retransplantations were identified as risk factors for hepatitis infections. At 5 years posttransplantation, kidney and liver functions did not differ significantly between HBV+ and HCV+ vs HBV-/HCV- renal transplant recipients.
由乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）感染导致的慢性肝病仍是肾移植受者的主要担忧问题。我们的目的是评估德国成年肾移植受者中HBV和HCV感染的患病率、危险因素及影响。
收集了1989年至2002年间在参与MOST（前瞻性多国移植观察研究）的21个德国肾移植中心接受移植的1633例肾移植受者的数据。亚组分析比较了移植时HBV和HCV阳性患者与HBV/HCV血清学阴性患者。
HBV感染率为4.4%（n = 72），HCV感染率为5.8%（n = 94），在过去15年中显著下降。再次移植在HBV阳性（29%）和HCV阳性（36%）患者中比HBV/HCV阴性患者（12%）更为常见。HCV阳性患者的透析时间明显更长，移植前接受的输血次数明显更多。在所有组之间，12个月时的急性排斥率或移植后5年内的肾移植功能均未观察到显著差异（平均肾小球滤过率：HBV阳性，57.3 mL/分钟；HCV阳性，58.5 mL/分钟；HBV/HCV阴性，59 mL/分钟）。在5年观察期内未发现肝酶和胆红素进行性升高。
目前德国肾移植受者中HBV和HCV感染的患病率较低。长透析时间、输血和再次移植被确定为肝炎感染的危险因素。移植后5年，HBV阳性和HCV阳性肾移植受者与HBV/HCV阴性肾移植受者之间的肾和肝功能无显著差异。
