Martí Josep, De la Serna Sofia, Crespo Gonzalo, Forns Xavier, Ferrer Joana, Fondevila Constantino, Navasa Miquel, Fuster Josep, García-Valdecasas Juan Carlos
Liver Surgery and Transplantation Unit, Institut de Malalties Digestives i Metabòliques, IDIBAPS, Hospital Clínic i Provincial, CIBERehd, University of Barcelona, Barcelona, Spain.
Clin Transplant. 2014 Jul;28(7):821-8. doi: 10.1111/ctr.12385. Epub 2014 Jun 12.
The use of liver retransplantation (ReLT) for hepatitis C virus (HCV) recurrence is controversial because of subsequent viral recurrence after ReLT.
Case-control analysis between patients undergoing ReLT for HCV reinfection between 1993 and 2012 (ReLT group: 26 patients) and patients undergoing liver transplantation (LT) for HCV infection immediately before and after each ReLT (LT group: 52 patients).
ReLT group had worse hepatocellular function, higher preoperative viral load, higher transfusion requirements, and increased number of postoperative complications than LT group. ReLT patients showed a trend toward worse graft survival compared with LT (five-yr graft survival: 42.3% vs. 64.3%, p = 0.145), but the rate of severe HCV recurrence and infection-free survival (IFS) was similar. The use of donors older than 60 yr led to a lower IFS and graft survival in both groups. Early severe HCV infection rate was similar in both groups, but it affected prognosis in ReLT more markedly than in LT (three-yr graft survival: 0% vs. 66.7%, p = 0.003).
ReLT for HCV reinfection has acceptable results when strict selection policies of donor and recipient are applied. However, early severe recurrence more markedly impairs prognosis in ReLT patients than in LT.
由于肝再次移植（ReLT）后丙型肝炎病毒（HCV）会复发，因此使用肝再次移植治疗HCV复发存在争议。
对1993年至2012年间因HCV再次感染接受ReLT的患者（ReLT组：26例患者）与每次ReLT前后因HCV感染接受肝移植（LT）的患者（LT组：52例患者）进行病例对照分析。
与LT组相比，ReLT组的肝细胞功能更差，术前病毒载量更高，输血需求更高，术后并发症数量更多。与LT相比，ReLT患者的移植物存活率有下降趋势（5年移植物存活率：42.3%对64.3%，p = 0.145），但严重HCV复发率和无感染生存期（IFS）相似。使用年龄大于60岁的供体导致两组的IFS和移植物存活率降低。两组的早期严重HCV感染率相似，但它对ReLT患者预后的影响比对LT患者更明显（3年移植物存活率：0%对66.7%，p = 0.003）。
当应用严格的供体和受体选择策略时，因HCV再次感染进行的ReLT有可接受的结果。然而，早期严重复发对ReLT患者预后的损害比对LT患者更明显。
