The Division of Gastroenterology, Henry Ford Health System, Detroit, MI, USA.
Am J Transplant. 2010 Mar;10(3):590-601. doi: 10.1111/j.1600-6143.2009.02880.x. Epub 2009 Dec 2.
We used the United Network for Organ Sharing Database to determine the influence of antibody-based induction therapy on patient and graft survival in orthotopic liver transplant (OLT) recipients with and without hepatitis C (HCV). We identified all initial OLT patients with HCV serology. Patients were divided into four groups: HCV positive without induction (17 362), HCV positive with induction (3479), HCV negative without induction (20 417) and HCV negative with induction (4357). Both HCV positive and negative patients who received induction did better than those who did not. For HCV positive patients, 5-year patient survival was 70.8% versus 68.7% (p = 0.004) and graft survival was 65.2% versus 62.1% (p < 0.001). For HCV negative patients, 5-year patient survival was 78.8% versus 76.7% (p < 0.001) and graft survival was 74.0% versus 70.8% (p < 0.001). On multivariate analysis, induction was associated with improved patient (HR = 0.91: p = 0.024) and graft (HR = 0.88: p < 0.001) survival in HCV positive patients and improved patient (HR = 0.87: p = 0.003) and graft survival (HR = 0.87: p < 0.001) in HCV negative patients. The benefit of induction occurred early and largely dissipated when patients with death within a year were censored. The benefit of induction therapy appeared most pronounced in patients with renal insufficiency or on organ-perfusion support at transplant.
我们利用美国器官共享网络数据库（United Network for Organ Sharing Database），确定了在患有和不患有丙型肝炎（hepatitis C，HCV）的原位肝移植（orthotopic liver transplant，OLT）受者中，基于抗体的诱导治疗对患者和移植物存活的影响。我们确定了所有 HCV 血清学阳性的初始 OLT 患者。患者被分为四组：HCV 阳性无诱导（17362 例）、HCV 阳性有诱导（3479 例）、HCV 阴性无诱导（20417 例）和 HCV 阴性有诱导（4357 例）。接受诱导治疗的 HCV 阳性和阴性患者均比未接受诱导治疗的患者预后更好。对于 HCV 阳性患者，5 年患者存活率为 70.8%对 68.7%（p=0.004），移植物存活率为 65.2%对 62.1%（p<0.001）。对于 HCV 阴性患者，5 年患者存活率为 78.8%对 76.7%（p<0.001），移植物存活率为 74.0%对 70.8%（p<0.001）。多变量分析显示，诱导治疗与 HCV 阳性患者的患者（HR=0.91：p=0.024）和移植物（HR=0.88：p<0.001）存活率的改善以及 HCV 阴性患者的患者（HR=0.87：p=0.003）和移植物（HR=0.87：p<0.001）存活率的改善相关。这种诱导治疗的获益在早期出现，并在排除一年内死亡的患者后基本消失。在肾功能不全或移植时器官灌注支持的患者中，诱导治疗的获益似乎最为显著。
