Satapathy Sanjaya K, Fiel Maria Isabel, Vanatta Jason M, Del Rio Martin Juan, Schiano Thomas D
Division of Liver Diseases, Department of Medicine, Mount Sinai Medical Center, New York, NY and the Division of Surgery, Methodist University Hospital Transplant Institute, University of Tennessee Health Sciences Center, Memphis, TN, USA.
Exp Clin Transplant. 2013 Dec;11(6):522-9. doi: 10.6002/ect.2013.0054. Epub 2013 Jul 30.
In living-donor liver transplant recipients with hepatitis C virus infection, outcomes of recurrent hepatitis C virus infection and fibrosis progression are not well documented. We evaluated fibrosis progression, response to pegylated interferon treatment, and long-term graft survival in living-donor liver transplant recipients who had hepatitis C virus infection.
In 48 transplant recipients, including 29 recipients who had follow-up liver biopsy ≥ 6 months after transplant, histology and clinical courses were reviewed. Outcomes were evaluated for patients grouped into slow and rapid fibrosis groups. Treatment with pegylated interferon and ribavirin was assessed in 18 patients.
Clinical features were similar between recipients with slow or rapid fibrosis. The time interval from transplant to recurrence of hepatitis C virus infection was significantly shorter in the recipients with rapid fibrosis. Recipients with rapid fibrosis had significantly greater confluent necrosis, acidophil bodies, and fibrosis score than recipients with slow fibrosis. Graft survival rates were similar between patients with slow or rapid fibrosis. Cumulative proportion of long-term graft survival was 60% at 7 years after transplant. Sustained virologic response was noted in 5 of 18 patients (28%) who received pegylated interferon and ribavirin.
In recipients of living-donor liver transplant with early recurrence of hepatitis C have worse fibrosis progression but graft survival was not affected. Therapy with pegylated interferon and ribavirin achieved sustained virologic response only in a small proportion of the patients.
在感染丙型肝炎病毒的活体肝移植受者中，丙型肝炎病毒复发感染的结局和纤维化进展情况尚无充分记录。我们评估了感染丙型肝炎病毒的活体肝移植受者的纤维化进展、对聚乙二醇化干扰素治疗的反应以及长期移植物存活情况。
对48例移植受者进行研究，其中29例在移植后≥6个月接受了随访肝活检，回顾了其组织学和临床病程。对分为纤维化进展缓慢组和快速组的患者的结局进行评估。对18例患者评估了聚乙二醇化干扰素和利巴韦林治疗情况。
纤维化进展缓慢或快速的受者临床特征相似。纤维化进展快速的受者从移植到丙型肝炎病毒复发感染的时间间隔显著更短。纤维化进展快速的受者比纤维化进展缓慢的受者有显著更多的融合性坏死、嗜酸性小体和纤维化评分。纤维化进展缓慢或快速的患者移植物存活率相似。移植后7年长期移植物存活的累积比例为60%。在接受聚乙二醇化干扰素和利巴韦林治疗的18例患者中，5例（28%）出现持续病毒学应答。
在丙型肝炎病毒早期复发的活体肝移植受者中，纤维化进展更差，但移植物存活未受影响。聚乙二醇化干扰素和利巴韦林治疗仅在一小部分患者中实现了持续病毒学应答。
