First Department of Pathology, National and Kapodistrian University of Athens, Athens, Greece.
Clin Transplant. 2013 Jan-Feb;27(1):72-9. doi: 10.1111/ctr.12012. Epub 2012 Sep 19.
This study aims to identify crucial factors affecting the evolution of liver disease in HCV-infected renal transplant recipients.
Forty-two HCV-infected recipients with known time of HCV acquisition were followed up for a mean (SD) of 7.6 ± 3.4 yr after transplantation with consecutive liver biopsies. Hepatitis progression was defined by: a) fibrosis progression ≥ 0.2 stages/yr and/or b) development of a cholestatic syndrome.
Twenty-three patients (54.8%) displayed benign and 19 (45.2%) aggressive hepatitis progression. Hepatitis course was aggressive in 9.1% and 85% of the patients infected pre- and peri/post-transplantation, respectively (p < 0.001). In multivariate analysis, patients who acquired HCV infection peri- or after transplantation had an increased risk of an adverse outcome compared with those infected before transplantation (p = 0.001). HCV RNA levels at the time of first liver biopsy were lower in patients showing a benign course compared with those with aggressive evolution (p = 0.052).
Time of acquisition of HCV infection is a major prognostic factor for hepatitis progression in the setting of renal transplantation. Immunosuppression was found to be determinant in the progression of HCV infection acquired peri- or post-transplantation. High viral load seems to be crucial in the pathogenetic process.
本研究旨在确定影响 HCV 感染肾移植受者肝病进展的关键因素。
42 例 HCV 感染受者在移植后平均（SD）7.6±3.4 年时进行了连续肝活检，已知 HCV 获得时间。肝炎进展定义为：a）纤维化进展≥0.2 期/年和/或 b）出现胆汁淤积综合征。
23 例（54.8%）表现为良性肝炎进展，19 例（45.2%）表现为侵袭性肝炎进展。感染前和移植前后感染的患者中，肝炎病程分别为侵袭性的比例为 9.1%和 85%（p<0.001）。多因素分析显示，与感染前相比，移植前后感染 HCV 的患者发生不良结局的风险增加（p=0.001）。与侵袭性演变相比，表现为良性病程的患者首次肝活检时 HCV RNA 水平较低（p=0.052）。
HCV 感染获得时间是肾移植后肝炎进展的主要预后因素。免疫抑制被认为是移植前后获得 HCV 感染进展的决定因素。高病毒载量似乎在发病机制中起关键作用。
