Korkmaz Murat, Fakı Sevgül, Öcal Serkan, Harmancı Özgür, Selçuk Haldun, Haberal Mehmet
From the Department of Gastroenterology and Hepatology, Başkent University, Faculty of Medicine, Ankara, Turkey.
Exp Clin Transplant. 2015 Apr;13 Suppl 1:159-64.
There is no correlation between alanine aminotransferase levels, viral load, and histologic findings at dialysis in patients with chronic hepatitis C virus infection. Identification of the severity of hepatitis C-related liver disease before transplant could provide valuable data about the risk for liverrelated mortality after transplant. In this study, we aimed to identify the severity of liver disease in endstage renal disease patients with chronic hepatitis C virus infection, the progression of hepatic histopathology after kidney transplant, and whether immunosuppressive therapy affected posttransplant viral replication and hepatic histology.
Antihepatitis C viruspositive kidney transplant recipients (45 patients) enrolled in the study. Liver biopsy was performed in 45 patients before and 16 patients after kidney transplant. Interferon was given to 28 of 45 patients before kidney transplant. Biopsy before and after kidney transplant was performed in 5 of 14 patients.
Patients had higher viral load, with genotype 1 predominancy (91%). Sustained viral response was achieved in 14 of 28 patients (50%). The histopathologic features of 45 patients who had pretransplant liver biopsy were as follows: 22 patients had mild hepatocellular injury, 17 patients had mild chronic hepatitis, 5 patients had moderate chronic hepatitis, and 1 patient had serious hepatitis. Follow-up biopsy after kidney transplant (mean, 2 y) in 16 of 45 patients showed that 3 of 16 patients had mild hepatocellular injury, 4 of 16 patients had mild hepatitis, 6 of 16 patients had moderate hepatitis, 2 of 16 patients had serious hepatitis, and 1 patient had cirrhosis. Patients showed neither progression, regression, nor stable liver histology.
Even with worse genotype profiles, chronic hepatitis C virus infection has an indolent progression in patients with end-stage renal disease and kidney transplant. Follow-up biopsies of kidney transplant recipients show reasonable progression during the first 2 years.
在慢性丙型肝炎病毒感染患者中，透析时丙氨酸氨基转移酶水平、病毒载量与组织学检查结果之间无相关性。移植前确定丙型肝炎相关肝病的严重程度可为移植后肝脏相关死亡率风险提供有价值的数据。在本研究中，我们旨在确定终末期肾病合并慢性丙型肝炎病毒感染患者的肝病严重程度、肾移植后肝组织病理学的进展情况，以及免疫抑制治疗是否会影响移植后病毒复制和肝脏组织学。
45例抗丙型肝炎病毒阳性的肾移植受者纳入本研究。45例患者在肾移植前及16例患者在肾移植后进行了肝活检。45例患者中有28例在肾移植前接受了干扰素治疗。14例患者中有5例在肾移植前后均进行了活检。
患者病毒载量较高，以1型基因型为主（91%）。28例患者中有14例（50%）实现了持续病毒学应答。45例移植前进行肝活检的患者的组织病理学特征如下：22例患者有轻度肝细胞损伤，17例患者有轻度慢性肝炎，5例患者有中度慢性肝炎，1例患者有重度肝炎。45例患者中有16例在肾移植后（平均2年）进行的随访活检显示，16例患者中有3例有轻度肝细胞损伤，4例有轻度肝炎，6例有中度肝炎，2例有重度肝炎，1例有肝硬化。患者的肝脏组织学既未进展，也未消退，也未保持稳定。
即使基因型情况较差，慢性丙型肝炎病毒感染在终末期肾病和肾移植患者中进展缓慢。肾移植受者的随访活检显示在最初2年内病情有合理进展。
