Zimmermann T, Otto C, Hoppe-Lotichius M, Biesterfeld S, Lautem A, Knaak M, Zimmermann A, Barreiros A P, Heise M, Schattenberg J M, Sprinzl M F, Galle P R, Otto G, Schuchmann M
First Department of Medicine, University of Mainz, Mainz, Germany.
Transplant Proc. 2009 Jul-Aug;41(6):2549-56. doi: 10.1016/j.transproceed.2009.06.120.
Recurrent cirrhosis (RC) due to pretransplant underlying disease leads to organ failure and subsequent death after orthotopic liver transplantation (OLT). RC occurs in up to 30% of patients with recurrent hepatitis C (HCV) within 5 years after OLT. We sought to identify early risk factors for rapid RC within the first year after OLT in HCV-positive patients.
Among 404 liver transplanted patients at the University of Mainz between 1998 and 2008, 90 were HCV-RNA positive. To identify predictive factors for rapid RC, we compared HCV-positive patients with advanced fibrosis stages within 1 year after OLT (n = 13) with these without RC at 5 years after OLT (n = 23).
Overall, poorer patient survival was associated with advanced fibrosis scores in the 1-year protocol biopsy and nonresponse to interferon treatment before OLT. The strongest predictive factors for rapid RC were persistently high levels of alkaline phosphatase, bilirubin, viral load at 6 months after OLT, and multiple steroid pulse therapies. The CCR2-V64I polymorphism was not associated with rapid RC.
We presented a group of patients with HCV-related rapid RC within the first year after OLT to identify predictive factors for rapid fibrosis progression.
移植前潜在疾病导致的复发性肝硬化（RC）会引发器官衰竭，并在原位肝移植（OLT）后导致患者死亡。OLT术后5年内，高达30%的丙型肝炎（HCV）复发患者会出现RC。我们试图确定HCV阳性患者OLT术后第一年内快速发生RC的早期危险因素。
在1998年至2008年间美因茨大学的404例肝移植患者中，90例HCV-RNA呈阳性。为了确定快速发生RC的预测因素，我们将OLT术后1年内出现晚期纤维化阶段的HCV阳性患者（n = 13）与OLT术后5年未发生RC的患者（n = 23）进行了比较。
总体而言，患者生存率较低与1年方案活检中的晚期纤维化评分以及OLT术前对干扰素治疗无反应有关。快速发生RC的最强预测因素是碱性磷酸酶、胆红素水平持续升高、OLT术后6个月的病毒载量以及多次类固醇脉冲疗法。CCR2-V64I多态性与快速发生RC无关。
我们展示了一组OLT术后第一年内发生HCV相关快速RC的患者，以确定快速纤维化进展的预测因素。
