Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA 94143, USA.
Liver Transpl. 2012 May;18(5):532-8. doi: 10.1002/lt.23396.
Over the last decade, the use of liver grafts from hepatitis C virus antibody-positive donors [HCV(+)Ds] has tripled in the United States. Although previous studies have demonstrated no association between an HCV(+)D status and graft loss, the effects of an HCV(+)D on histological outcomes are not well known. Hepatitis C virus (HCV)-infected recipients at 5 US centers (2002-2007) who survived more than 30 days with 1 or more posttransplant biopsy samples were included. Cox regression was used to examine the association between an HCV(+)D status and advanced fibrosis (stage 3/4 or higher). Ninety-nine of the 1206 patients (8%) received an HCV(+)D graft. Recipients of HCV(+)D grafts were older than recipients of hepatitis C virus antibody-negative donor [HCV(-)D] grafts (P = 0.03), but they were otherwise similar. HCV(+)D grafts were significantly lower in quality according to the donor risk index (P < 0.001). Advanced fibrosis occurred in 32% of HCV(+)D graft recipients and in 28% of HCV(-)D graft recipients (P = 0.39). The unadjusted 1- and 3-year rates of advanced fibrosis were significantly higher for HCV(+)D graft recipients (14% and 48%) versus HCV(-)D graft recipients (7% and 33%, P = 0.01). Transplantation with HCV(+)D grafts was associated with a 58% increased risk of advanced fibrosis [95% confidence interval (CI) = 1.05-2.36, P = 0.03]. However, in an analysis stratified by the mean donor age of 45 years, an HCV(+)D status was associated with advanced fibrosis only with donors >45 years old [hazard ratio (HR) = 1.76, 95% CI = 1.06-2.93, P = 0.03] and not with donors ≤45 years old (HR = 0.94, 95% CI = 0.47-1.87, P = 0.85). In conclusion, a careful consideration of the risks and benefits is needed with HCV(+)D grafts. Recipients of HCV(+)D grafts (especially from older donors) should undergo close monitoring for more rapidly progressive fibrosis. Studies are needed to determine whether early HCV therapy modifies this risk.
在过去的十年中，美国使用丙型肝炎病毒抗体阳性供体[HCV（+）D]的肝移植物的数量增加了两倍。尽管先前的研究表明 HCV（+）D 状态与移植物丢失之间没有关联，但 HCV（+）D 对组织学结果的影响尚不清楚。2002-2007 年间，美国 5 个中心的 HCV 感染受者接受了 1 个或多个移植后活检样本，存活时间超过 30 天。使用 Cox 回归来检查 HCV（+）D 状态与晚期纤维化（3/4 期或更高）之间的关系。1206 名患者中有 99 名（8%）接受了 HCV（+）D 移植物。接受 HCV（+）D 移植物的受者比接受丙型肝炎病毒抗体阴性供体[HCV（-）D]移植物的受者年龄更大（P = 0.03），但其他方面相似。根据供体风险指数，HCV（+）D 移植物的质量明显较低（P < 0.001）。32%的 HCV（+）D 移植物受者和 28%的 HCV（-）D 移植物受者发生晚期纤维化（P = 0.39）。未调整的 1 年和 3 年高级纤维化发生率，HCV（+）D 移植物受者（14%和 48%）显著高于 HCV（-）D 移植物受者（7%和 33%，P = 0.01）。与 HCV（-）D 移植物受者相比，HCV（+）D 移植物受者的晚期纤维化风险增加了 58%[95%置信区间（CI）= 1.05-2.36，P = 0.03]。然而，在根据 45 岁的平均供体年龄进行分层分析时，仅在供体>45 岁时，HCV（+）D 状态与晚期纤维化相关[危险比（HR）= 1.76，95%CI = 1.06-2.93，P = 0.03]，而在供体≤45 岁时不相关（HR = 0.94，95%CI = 0.47-1.87，P = 0.85）。总之，需要仔细考虑 HCV（+）D 移植物的风险和益处。HCV（+）D 移植物受者（尤其是来自年龄较大供体的受者）应密切监测，以观察更迅速进展的纤维化。需要进行研究以确定早期 HCV 治疗是否会改变这种风险。
