Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
Liver Transpl. 2010 Nov;16(11):1288-95. doi: 10.1002/lt.22168.
Many factors can worsen a recurrent hepatitis C virus (HCV) infection after liver transplantation (LT). We sought to determine whether the use of donation after cardiac death (DCD) livers affects HCV recurrence. From January 2000 to June 2008, 37 HCV patients underwent LT with DCD allografts. The outcomes and severity of HCV recurrence were analyzed along with those for 74 matched control patients with HCV who received donation after brain death (DBD) livers. The 2 groups had similar donor and recipient characteristics, immunosuppression regimens, rates of acute cellular rejection (ACR), and HCV profiles. DCD patients had a higher incidence of primary nonfunction (19% versus 3%, P = 0.006) and significantly higher peak aspartate aminotransferase levels in comparison with DBD subjects, suggesting a greater degree of ischemia/reperfusion injury. Although the survival rates were not significantly different, DCD recipients had lower 1- and 5-year patient survival rates (83% and 69% versus 84% and 78%, respectively, P = 0.75) and graft survival rates (70% and 61% versus 82% and 74%, respectively, P = 0.24). Three hundred fourteen protocol and clinically indicated liver biopsy procedures were performed within 6 years after transplantation, and mixed modeling analysis showed that fibrosis progression rates were similar for the 2 groups (0.6 fibrosis units/year according to the Ishak modified staging system). The rates of severe HCV recurrence (retransplantation or death due to recurrent hepatitis C and/or the development of stage 4/6 fibrosis or worse within 2 years) were similar [3 DCD patients (8%) versus 11 DBD patients (15%), P = 0.38], and cytomegalovirus infection (hazard ratio = 7.9, P = 0.002, 95% confidence interval = 2.1-28.9) and ACR (hazard ratio = 6.2, P = 0.002, 95% confidence interval = 2.0-19.7) were the only independent risk factors for severe recurrence. In summary, although there was a trend of poorer overall outcomes in DCD patients, the use of DCD livers did not appear to adversely affect HCV recurrence after LT.
许多因素可导致肝移植（LT）后丙型肝炎病毒（HCV）复发。我们旨在确定心脏死亡后供肝（DCD）的使用是否影响 HCV 复发。2000 年 1 月至 2008 年 6 月，37 例 HCV 患者接受 DCD 异体肝移植。分析 HCV 复发的结局和严重程度，并与 74 例接受脑死亡（DBD）供肝的 HCV 匹配对照患者进行比较。两组供者和受者特征、免疫抑制方案、急性细胞排斥反应（ACR）发生率和 HCV 特征相似。DCD 患者原发性无功能（19%与 3%，P = 0.006）和天冬氨酸转氨酶峰值较高，提示缺血再灌注损伤程度更大。虽然存活率无显著差异，但 DCD 受者的 1 年和 5 年患者生存率（83%和 69%与 84%和 78%，P = 0.75）和移植物生存率（70%和 61%与 82%和 74%，P = 0.24）较低。移植后 6 年内进行了 314 次方案和临床指示性肝活检，混合模型分析显示两组的纤维化进展率相似（Ishak 改良分期系统为 0.6 纤维化单位/年）。2 年内因复发性丙型肝炎和/或发展为 4/6 期纤维化或更严重的纤维化而再次肝移植或死亡的严重 HCV 复发率相似[3 例 DCD 患者（8%）与 11 例 DBD 患者（15%），P = 0.38]，巨细胞病毒感染（风险比 = 7.9，P = 0.002，95%置信区间 = 2.1-28.9）和 ACR（风险比 = 6.2，P = 0.002，95%置信区间 = 2.0-19.7）是严重复发的唯一独立危险因素。总之，尽管 DCD 患者的整体结局呈恶化趋势，但 LT 后使用 DCD 肝并未对 HCV 复发产生不利影响。
