Krawczyk Marek, Grat Michał, Kornasiewicz Oskar, Lewandowski Zbigniew, Barski Krzysztof, Ligocka Joanna, Grat Karolina, Antczak Arkadiusz, Skalski Michał, Patkowski Waldemar, Nyckowski Paweł, Zieniewicz Krzysztof, Grzelak Ireneusz, Pawlak Jacek, Alsharabi Abdulsalam, Wróblewski Tadeusz, Paluszkiewicz Rafał, Najnigier Bogusław, Dudek Krzysztof, Remiszewski Piotr, Smoter Piotr, Grodzicki Mariusz, Korba Michał, Kotulski Marcin, Cieślak Bartosz, Kalinowski Piotr, Gierej Piotr, Fraczek Mariusz, Rdzanek Łukasz, Stankiewicz Rafał, Kobryń Konrad, Nazarewski Łukasz, Giercuszkiewicz Dorota, Piwowarska Jolanta, Brudkowska Anna, Andrzejewska Renata, Niewiński Grzegorz, Kilińska Beata, Zarzycka Aleksandra, Nowak Robert, Kosiński Cezary, Korta Teresa, Ołdakowska-Jedynak Urszula, Sańko-Resmer Joanna, Foroncewicz Bartosz, Ziółkowski Jacek, Mucha Krzysztof, Senatorski Grzegorz, Paczek Leszek, Habior Andrzej, Lechowicz Robert, Polański Sławomir, Pacho Ryszard, Andrzejewska Małgorzata, Rowiński Olgierd, Kozieł Sławomir, Ziarkiewicz-Wróblewska Bogna, Górnicka Barbara, Hevelke Piotr, Cianciara Janusz, Wiercińska-Drapało Alicja, Michałowicz Bogdan, Karwowski Andrzej, Szczerbań Jerzy
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Poland.
Przegl Epidemiol. 2013;67(1):5-10, 93-7.
Cirrhosis related to hepatitis C virus (HCV) and hepatitis B virus (HBV) infection is the most frequent indication for liver transplantation worldwide. Progress in prophylaxis of posttransplant HBV recurrence has led to major improvements in long-term outcomes of patients after liver transplantation. Conversely, impaired posttransplant survival of patients with HCV infection was reported in several studies, mainly due to recurrence of viral infection. The purpose of this study was to compare long-term results of liver transplantation between patients with HBV monoinfection, HCV monoinfection and HBV/HCV coinfection.
A total of 1090 liver transplantations were performed in the Department of General, Transplant and Liver Surgery in cooperation with the Department of Immunology, Internal Medicine, and Transplantology at the Transplantation Institute Medical University of Warsaw between December 1994 and May 2012. After exclusion of patients with cirrhosis of non-viral etiology, patients with malignant tumors, and patients with acute liver failure, the final study cohort comprised 209 patients with HBV (HBV+/HCV- subgroup; n = 56) or HCV (HBV-/HCV+ subgroup; n = 119) monoinfection or HBV/HCV coinfection (HBV+/HCV+; n = 34). These subgroups of patients were compared in terms of long-term results of transplantations, defined by 5-year patient and 5-year graft survival estimates.
Overall and graft survival rates after 5-years for the whole study cohort were 74.5% and 72.6%, respectively. Five-year overall survival was 70.4% for patients within the HBV+/HCV- subgroup, 77.8% for patients within the HBV-/HCV+ subgroup, and 68.5% for patients within the HBV+/HCV+ subgroup. The corresponding rates of graft survival were 67.0%, 76.3%, and 68.5% for patients within the HBV+/HCV-, HBV-/ HCV+, and HBV+/HCV+ subgroups, respectively. Observed differences were non-significant, both in terms of overall (p = 0.472) and graft (p = 0.461) survival rates.
Both overall and graft survival rates after liver transplantations performed in the Department of General, Transplant and Liver Surgery in cooperation with the Department of Immunology, Internal Medicine, and Transplantology at the Transplantation Institute Medical University of Warsaw in patients with HBV and HCV infection are comparable to those reported by other European and American centers. In contrast to other studies, obtained results do not confirm the negative impact of HCV infection on long-term outcomes of patients.
丙型肝炎病毒（HCV）和乙型肝炎病毒（HBV）感染相关的肝硬化是全球肝移植最常见的适应证。移植后预防HBV复发方面的进展已使肝移植患者的长期预后有了重大改善。相反，几项研究报告了HCV感染患者移植后生存率受损，主要原因是病毒感染复发。本研究的目的是比较HBV单一感染、HCV单一感染和HBV/HCV合并感染患者肝移植的长期结果。
1994年12月至2012年5月期间，华沙医科大学移植研究所普通、移植和肝脏外科与免疫学、内科和移植学系合作，共进行了1090例肝移植。排除非病毒病因肝硬化患者、恶性肿瘤患者和急性肝衰竭患者后，最终研究队列包括209例HBV单一感染（HBV+/HCV-亚组；n = 56）或HCV单一感染（HBV-/HCV+亚组；n = 119）或HBV/HCV合并感染（HBV+/HCV+；n = 34）的患者。根据5年患者生存率和5年移植物生存率评估来定义移植的长期结果，对这些患者亚组进行比较。
整个研究队列5年后的总生存率和移植物生存率分别为74.5%和72.6%。HBV+/HCV-亚组患者的5年总生存率为70.4%，HBV-/HCV+亚组患者为77.8%，HBV+/HCV+亚组患者为68.5%。HBV+/HCV-、HBV-/HCV+和HBV+/HCV+亚组患者相应的移植物生存率分别为67.0%、76.3%和68.5%。观察到的差异在总生存率（p = 0.472）和移植物生存率（p = 0.461）方面均无统计学意义。
华沙医科大学移植研究所普通、移植和肝脏外科与免疫学、内科和移植学系合作，对HBV和HCV感染患者进行肝移植后的总生存率和移植物生存率与其他欧美中心报告的结果相当。与其他研究不同，本研究结果未证实HCV感染对患者长期预后有负面影响。
