Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
J Heart Lung Transplant. 2011 Nov;30(11):1266-74. doi: 10.1016/j.healun.2011.06.003. Epub 2011 Jul 20.
Transplant centers are reluctant to perform heart transplantation in patients with hepatitis C virus (HCV) infection because augmented immunosuppression could potentially increase mortality. However, there have been few studies examining whether HCV infection reduces survival after heart transplantation.
We used data from the the U.S. Scientific Registry of Transplant Recipients to perform a multicenter cohort study evaluating the association between recipient pre-transplant HCV status and survival after heart transplantation. Adults undergoing heart transplantation between January 1, 1993 and December 31, 2007 were eligible to participate.
Among 20,687 heart transplant recipients (443 HCV-positive and 20,244 HCV-negative) at 103 institutions followed for a mean of 5.6 years, mortality was higher among HCV-positive than HCV-negative recipients (177 [40%] vs 6,367 [31.5%]; p = 0.0001). After matching on propensity score, hospital and gender, the hazard ratio (HR) of death for HCV-positive heart transplant recipients was 1.32 (95% confidence interval [CI] 1.08 to 1.61). Mortality rates were higher among HCV-positive heart transplant recipients at 1 year (9.4% vs 8.2%), 5 years (26.3% vs 22.9%), 10 years (53.1% vs 43.4%) and 15 years (74.8% vs 62.3%) post-transplantation. HRs did not vary by gender or overall number of heart transplantations performed at the center.
Pre-transplant HCV positivity is associated with decreased survival after heart transplantation.
移植中心不愿意为丙型肝炎病毒（HCV）感染者进行心脏移植，因为增强免疫抑制可能会增加死亡率。然而，很少有研究探讨 HCV 感染是否会降低心脏移植后的生存率。
我们使用美国移植受者科学注册处的数据进行了一项多中心队列研究，评估了受体移植前 HCV 状态与心脏移植后生存率之间的关系。1993 年 1 月 1 日至 2007 年 12 月 31 日期间在 103 家机构接受心脏移植的成年人有资格参加。
在 20687 例心脏移植受者（443 例 HCV 阳性和 20244 例 HCV 阴性）中，中位随访时间为 5.6 年，HCV 阳性受者的死亡率高于 HCV 阴性受者（177 [40%]比 6367 [31.5%]；p=0.0001）。在匹配倾向评分、医院和性别后，HCV 阳性心脏移植受者的死亡风险比（HR）为 1.32（95%置信区间 [CI] 1.08 至 1.61）。HCV 阳性心脏移植受者的 1 年、5 年、10 年和 15 年的死亡率分别为 9.4%、26.3%、53.1%和 74.8%，均高于 HCV 阴性受者。HR 在性别或中心进行的心脏移植总数上无差异。
移植前 HCV 阳性与心脏移植后生存率降低相关。
