Department of Medicine, Carolinas Medical Center, Charlotte, NC 28203, USA.
Liver Transpl. 2010 Nov;16(11):1228-35. doi: 10.1002/lt.22175.
Liver transplantation is currently the only definitive modality for the treatment of end-stage liver disease due to chronic hepatitis C. However, recurrent hepatitis C after liver transplantation is nearly universal. Cirrhosis may develop in 20% of recipients within 5 years, and recurrent hepatitis C may lead to graft failure, retransplantation, and even death. A subset of recipients may develop post-liver transplant cholestatic hepatitis C (PLTCHC), which is characterized by cholestasis, hepatocyte ballooning, and rapid progression to graft failure. We present a systematic review of PLTCHC that is focused on hepatitis C-infected liver transplant recipients. We compare the pathological definitions of PLTCHC, clinical factors, management strategies, and outcomes reported in studies. We found differences among studies in the types of histological criteria used to diagnose PLTCHC during liver biopsy and in the types of clinical information provided. Three of the 12 studies published after 2003 used the definition of PLTCHC published by the first International Liver Transplantation Society expert panel consensus conference on liver transplantation and hepatitis C. We propose that studies on PLTCHC use the consensus criteria for diagnosis and suggest clinical information that should be provided in future studies with the goal of improving our understanding and management of this deadly disease.
肝移植是治疗慢性丙型肝炎终末期肝病的唯一有效方法。然而，肝移植后丙型肝炎的复发几乎是普遍的。20%的受者在 5 年内可能会发展为肝硬化，丙型肝炎的复发可能导致移植物失功、再次移植甚至死亡。一部分受者可能会发展为肝移植后胆淤性丙型肝炎（PLTCHC），其特征为胆汁淤积、肝细胞气球样变，并迅速进展为移植物失功。我们对丙型肝炎感染肝移植受者的 PLTCHC 进行了系统综述。我们比较了研究中报道的 PLTCHC 的病理学定义、临床因素、管理策略和结局。我们发现，在肝活检中用于诊断 PLTCHC 的组织学标准类型以及提供的临床信息类型在研究之间存在差异。在 2003 年之后发表的 12 项研究中有 3 项使用了首次国际肝移植学会专家小组关于肝移植和丙型肝炎的共识会议上发表的 PLTCHC 定义。我们建议将共识标准用于 PLTCHC 的诊断，并建议在未来的研究中提供应提供的临床信息，以提高我们对这种致命疾病的认识和管理。
