Terasaki Foundation Laboratory, Angeles, CA, USA.
Transplantation. 2011 Oct 15;92(7):809-14. doi: 10.1097/TP.0b013e31822d4dc3.
Coinfection by Hepatitis B virus (HBV) and hepatitis C virus (HCV) has been reported to increase risk of graft failure for liver transplant recipients. But other studies have controverted that finding. The aim of this study was to determine whether-after adjustments for other important predictors-HBV/HCV coinfection was associated with worse liver graft survival than HBV or HCV mono-infection.
A retrospective cohort study examined Organ Procurement and Transplantation Network/United Network Organ Sharing data for 48,654 deceased-donor primary liver-only transplants that were performed on adults between January 1, 1995, and August 31, 2009, and that included recipient and donor HBV/HCV status. Recipients were classified into four groups: the HBV/HCV coinfected [B+/C+]; HBV mono-infected [B+/C-]; HCV mono-infected [B-/C+]; and hepatitis uninfected [B-/C-]. Kaplan-Meier methods were used to calculate liver graft survival rates, Cox proportional hazard models were used to estimate the effect of hepatitis virus infection, and adjusted for potential confounders.
Graft survival rates were highest with B+/C-: 85.3% 1-year survival and 63.0% 10-year survival. Graft survival with B+/C+ was superior to survival with B-/C+: 83.5% 1-year survival and 53.6% 10-year survival vs. B-/C+: 82.9% 1-year survival and 46.1% 10-year survival. Survival with B-/C-: 83.6% 1-year survival and 56.6% 10-year survival was superior to survival with B+/C+ (shown above). After adjustment for confounders, and with the coinfected as reference, B-/C+ recipients had a higher risk of graft loss (hazard ratio, 1.35; 95% CI, 1.10-1.66); the other two groups had a lower risk.
Our results suggested-despite reports to the contrary-statistically better graft outcomes with HBV/HCV coinfection than with HCV mono-infection.
乙肝病毒（HBV）和丙型肝炎病毒（HCV）的合并感染已被报道会增加肝移植受者发生移植物失败的风险。但其他研究对这一发现提出了质疑。本研究的目的是确定在调整其他重要预测因素后，HBV/HCV 合并感染是否与 HBV 或 HCV 单感染相比，导致更差的肝移植移植物存活率。
一项回顾性队列研究分析了 1995 年 1 月 1 日至 2009 年 8 月 31 日期间，在成人中进行的 48654 例尸源供肝单独移植的器官获取和移植网络/联合网络器官共享数据，这些数据包括受者和供者的 HBV/HCV 状态。受者被分为四组：HBV/HCV 合并感染[B+/C+]；HBV 单感染[B+/C-]；HCV 单感染[B-/C+]；以及未感染肝炎[B-/C-]。Kaplan-Meier 法计算肝移植移植物存活率，Cox 比例风险模型估计病毒感染的影响，并调整潜在混杂因素。
B+/C-组的移植物存活率最高：1 年存活率为 85.3%，10 年存活率为 63.0%。与 B-/C+相比，B+/C+的移植物存活率优于 B-/C-：1 年存活率为 83.5%，10 年存活率为 53.6%；1 年存活率为 82.9%，10 年存活率为 46.1%。B-/C-组：1 年存活率为 83.6%，10 年存活率为 56.6%，优于 B+/C+（如上所述）。在调整混杂因素后，以合并感染为参照，B-/C+受者发生移植物丢失的风险更高（危险比，1.35；95%可信区间，1.10-1.66）；其他两组的风险较低。
尽管有相反的报告，但我们的研究结果表明，与 HCV 单感染相比，HBV/HCV 合并感染具有统计学上更好的移植物结局。
