Carbone Marco, Neuberger James
Liver Unit, Queen Elizabeth Hospital, Birmingham B152TH, UK.
J Transplant. 2010;2010:893893. doi: 10.1155/2010/893893. Epub 2010 Dec 15.
End-stage liver disease due to hepatitis C (HCV) and cirrhosis from alcohol (ALD) are the commonest indications for liver transplantation in the western countries. Up to one third of HCV-infected transplant candidates have a history of significant alcohol intake prior to transplantation. However, there are few data available about the possible interaction between alcohol and HCV in the post-transplant setting. Patients with both HCV and alcohol are more likely to die on the waiting list than those with ALD and HCV alone. However, after transplantation, non-risk adjusted graft and patient survival of patients with HCV + ALD are comparable to those of patients with HCV cirrhosis or ALD cirrhosis alone. In the short and medium term HCV recurrence after transplant in patients with HCV + ALD cirrhosis does not seem more aggressive than that in patients with HCV cirrhosis alone. A relapse in alcohol consumption in patients with HCV + ALD cirrhosis does not have a major impact on graft survival. The evidence shows that, as is currently practiced, HCV + ALD as an appropriate indication for liver transplantation. However, these data are based on retrospective analyses with relatively short follow-up so the conclusions must be treated with caution.
丙型肝炎（HCV）导致的终末期肝病和酒精性肝硬化（ALD）是西方国家肝移植最常见的适应症。高达三分之一的感染HCV的移植候选者在移植前有大量饮酒史。然而，关于移植后酒精与HCV之间可能的相互作用，可用数据很少。与仅患有ALD和HCV的患者相比，同时患有HCV和酒精的患者更有可能在等待名单上死亡。然而，移植后，HCV+ALD患者未经风险调整的移植物和患者生存率与仅患有HCV肝硬化或ALD肝硬化的患者相当。在短期和中期，HCV+ALD肝硬化患者移植后HCV复发似乎并不比仅患有HCV肝硬化的患者更具侵袭性。HCV+ALD肝硬化患者饮酒复发对移植物存活没有重大影响。证据表明，按照目前的做法，HCV+ALD是肝移植的合适适应症。然而，这些数据基于随访相对较短的回顾性分析，因此结论必须谨慎对待。
