肝活检在抗丙型肝炎病毒抗体阳性和丙型肝炎病毒 RNA 阴性肾移植受者中的作用。

Usefulness of liver biopsy in anti-hepatitis C virus antibody-positive and hepatitis C virus RNA-negative kidney transplant recipients.

机构信息

Division of Nephrology, Department of Internal Medicine, Jeju National University Hospital, Jeju, South Korea.

出版信息

Transplantation. 2013 Jul 15;96(1):85-90. doi: 10.1097/TP.0b013e318294cad1.

DOI:10.1097/TP.0b013e318294cad1

PMID:23632392

Abstract

BACKGROUND

Some guidelines recommend a liver biopsy to all anti-hepatitis C virus (HCV) antibody-positive kidney transplant (KT) recipients. However, in the case of HCV RNA-negative KT recipients, the benefit of a liver biopsy is unclear. We examined the usefulness of a liver biopsy for anti-HCV antibody-positive and HCV RNA-negative patients by analyzing the hepatic histologic findings and clinical outcomes.

METHODS

A total of 30 anti-HCV antibody-positive patients who underwent liver biopsy before KT at Asan Medical Center were retrospectively recruited. The patients were divided into two groups based on HCV RNA positivity: 17 patients were positive and 13 patients were negative. Histologic evidence of hepatic inflammation and fibrosis was assessed using the METAVIR score, and clinical outcomes, including mortality, graft loss, and progression of liver disease, were compared.

RESULTS

The mean histologic activity scores for inflammation and fibrosis for the HCV RNA-positive and HCV RNA-negative groups were significantly different (inflammation score 1.11 ± 0.85 vs. 0.46 ± 0.51; P=0.01 and fibrosis score 1.05 ± 1.24 vs. 0.15 ± 0.37; P=0.01, respectively). The overall rates of mortality and graft loss were not significantly different between the two groups. Progression of liver disease was noted in the HCV RNA-positive group only.

CONCLUSION

The HCV RNA-negative group showed no evidence of liver disease progression. Neither did they show any histologic evidence of liver inflammation and fibrosis before KT. Therefore, it appears that liver biopsy is not necessary in anti-HCV antibody-positive and HCV RNA-negative KT recipients.

摘要

背景

一些指南建议对所有抗丙型肝炎病毒（HCV）抗体阳性的肾移植（KT）受者进行肝活检。然而，在 HCV RNA 阴性的 KT 受者中，肝活检的益处尚不清楚。我们通过分析肝组织学发现和临床结果，检查了肝活检对 HCV 抗体阳性和 HCV RNA 阴性患者的有用性。

方法

回顾性招募了在 Asan 医疗中心接受 KT 前接受肝活检的 30 名抗 HCV 抗体阳性患者。根据 HCV RNA 阳性将患者分为两组：17 名患者阳性，13 名患者阴性。使用 METAVIR 评分评估肝炎症和纤维化的组织学证据，并比较临床结果，包括死亡率、移植物丢失和肝病进展。

结果

HCV RNA 阳性和 HCV RNA 阴性组的平均组织学活动评分在炎症和纤维化方面有显著差异（炎症评分 1.11 ± 0.85 对 0.46 ± 0.51；P=0.01 和纤维化评分 1.05 ± 1.24 对 0.15 ± 0.37；P=0.01）。两组的死亡率和移植物丢失率无显著差异。仅在 HCV RNA 阳性组中观察到肝病进展。