Gitto Stefano, Belli Luca Saverio, Vukotic Ranka, Lorenzini Stefania, Airoldi Aldo, Cicero Arrigo Francesco Giuseppe, Vangeli Marcello, Brodosi Lucia, Panno Arianna Martello, Di Donato Roberto, Cescon Matteo, Grazi Gian Luca, De Carlis Luciano, Pinna Antonio Daniele, Bernardi Mauro, Andreone Pietro
Stefano Gitto, Ranka Vukotic, Stefania Lorenzini, Arrigo Francesco Giuseppe Cicero, Lucia Brodosi, Arianna Martello Panno, Roberto Di Donato, Matteo Cescon, Gian Luca Grazi, Antonio Daniele Pinna, Mauro Bernardi, Pietro Andreone, Department of Medical and Surgical Sciences, University of Bologna and Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola Malpighi, 40138 Bologna, Italy.
World J Gastroenterol. 2015 Apr 7;21(13):3912-20. doi: 10.3748/wjg.v21.i13.3912.
To evaluate the predictors of 10-year survival of patients with hepatitis C recurrence.
Data from 358 patients transplanted between 1989 and 2010 in two Italian transplant centers and with evidence of hepatitis C recurrence were analyzed. A χ(2), Fisher's exact test and Kruskal Wallis' test were used for categorical and continuous variables, respectively. Survival analysis was performed at 10 years after transplant using the Kaplan-Meier method, and a log-rank test was used to compare groups. A P level less than 0.05 was considered significant for all tests. Multivariate analysis of the predictive role of different variables on 10-year survival was performed by a stepwise Cox logistic regression.
The ten-year survival of the entire population was 61.2%. Five groups of patients were identified according to the virological response or lack of a response to antiviral treatment and, among those who were not treated, according to the clinical status (mild hepatitis C recurrence, "too sick to be treated" and patients with comorbidities contraindicating the treatment). While the 10-year survival of treated and untreated patients was not different (59.1% vs 64.7%, P = 0.192), patients with a sustained virological response had a higher 10-year survival rate than both the "non-responders" (84.7% vs 39.8%, P < 0.0001) and too sick to be treated (84.7% vs 0%, P < 0.0001). Sustained virological responders had a survival rate comparable to patients untreated with mild recurrence (84.7% vs 89.3%). A sustained virological response and young donor age were independent predictors of 10-year survival.
Sustained virological response significantly increased long-term survival. Awaiting the interferon-free regimen global availability, antiviral treatment might be questionable in selected subjects with mild hepatitis C recurrence.
评估丙型肝炎复发患者复发复发患者10年生存率的预测因素。
分析了1989年至2010年间在意大利两个移植中心接受移植且有丙型肝炎复发证据的358例患者的数据。分别对分类变量和连续变量使用χ²检验、Fisher精确检验和Kruskal Wallis检验。移植后10年采用Kaplan-Meier法进行生存分析，并用对数秩检验比较各组。所有检验中P值小于0.05被认为具有显著性。通过逐步Cox逻辑回归对不同变量对10年生存率的预测作用进行多变量分析。
整个人群的10年生存率为61.2%。根据病毒学应答情况或对抗病毒治疗无应答情况，以及在未接受治疗的患者中根据临床状态（轻度丙型肝炎复发、“病情过重无法治疗”和有合并症禁忌治疗的患者）将患者分为五组。虽然接受治疗和未接受治疗患者的10年生存率无差异（59.1%对64.7%，P = 0.192），但病毒学应答持续的患者10年生存率高于“无应答者”（84.7%对39.8%，P < 0.0001）和病情过重无法治疗的患者（84.7%对0%，P < 0.0001）。病毒学应答持续者的生存率与轻度复发未接受治疗的患者相当（84.7%对89.3%）。病毒学应答持续和供体年龄较小是10年生存率的独立预测因素。
病毒学应答持续显著提高长期生存率。在无干扰素方案全球可用之前，对于轻度丙型肝炎复发的特定患者，抗病毒治疗可能存在疑问。
