Manzia T M, Di Paolo D, Sforza D, Toti L, Angelico R, Brega A, Angelico M, Tisone G
Transplant Unit, Department of Surgery, University of Rome Tor Vergata, Rome, Italy.
Transplant Proc. 2010 May;42(4):1200-3. doi: 10.1016/j.transproceed.2010.03.111.
Hepatitis C virus (HCV) recurrence after orthotopic liver transplantation (OLT) is almost universal; cirrhosis develops in up to 30% of cases. Currently there is interest in the midterm outcomes of HCV patients with concomitant hepatitis B virus (HBV) infection among OLT recipients. We therefore retrospectively analyzed our database of patients who underwent OLT for HCV-HBV-related cirrhosis. Between April 1992 and December 2008, 350 patients underwent OLT, including 20 (5.7%) transplanted for HBV-HCV cirrhosis. We assessed patient and graft survivals at 1 and 5 years, as well as the progression of fibrosis. Protocol liver biopsies were available yearly after OLT. The survival curves were analyzed by the Kaplan-Meier approach and chronic hepatitis evaluated according to the Ishak scoring system. At a median follow-up of 68.4 +/- 53 months, the 1- and 5-year patient and graft survival rates were 80% and 70%, respectively. The 5-year fibrosis progression rate was 0.17 +/- 0.08 units of fibrosis. The only patient who developed histologic cirrhosis within 10 years of follow-up showed a lamivudine-resistant HBV recurrence. Patients transplanted for HBV-HCV coinfection showed a lower fibrosis progression rate compared with HCV monoinfected subjects.
原位肝移植（OLT）后丙型肝炎病毒（HCV）复发几乎是普遍现象；高达30%的病例会发展为肝硬化。目前，OLT受者中合并乙型肝炎病毒（HBV）感染的HCV患者的中期结局受到关注。因此，我们回顾性分析了因HCV-HBV相关肝硬化接受OLT的患者数据库。1992年4月至2008年12月期间，350例患者接受了OLT，其中20例（5.7%）因HBV-HCV肝硬化接受移植。我们评估了患者和移植物1年和5年的生存率以及纤维化进展情况。OLT术后每年进行常规肝脏活检。采用Kaplan-Meier方法分析生存曲线，并根据Ishak评分系统评估慢性肝炎。中位随访时间为68.4±53个月，1年和5年的患者及移植物生存率分别为80%和70%。5年纤维化进展率为0.17±0.08纤维化单位。在随访10年内发生组织学肝硬化的唯一患者表现出对拉米夫定耐药的HBV复发。与单纯HCV感染患者相比，因HBV-HCV合并感染接受移植的患者纤维化进展率较低。
