Fernandes A R, Laranjinha I J, Birne R, Matias P, Jorge C, Adragão T, Bruges M, Weigert A, Machado D
Department of Nephrology, Hospital São Bernardo, Setúbal, Portugal.
Department of Nephrology, Hospital Santa Cruz, Carnaxide, Portugal.
Int J Organ Transplant Med. 2017;8(2):104-109. Epub 2017 May 1.
Natural history of HCV-infected renal transplant recipients is about to change with the invention of new drugs available for the treatment of HCV.
To analyze the evolution of renal transplant recipients infected with HCV in 30 years of activity of a Renal Transplantation Unit.
We studied 1334 patients who underwent renal transplantation between 1985 and 2015.
189 (14.2%) of these 1334 were found HCV seropositive. 60 were HCV RNA-positive for >6 months. 5 died with a functioning graft; 19 lost their graft and resumed dialysis. Most of the rejections occurred within the first year of the transplantation and none resulted in immediate loss of the graft. In post-transplantation period, 14 patients developed clinical hepatic disease, 10 manifested new-onset diabetes after transplantation, and 4 had neoplasia, none of them had hepatocellular carcinoma. The outcomes of the different variables analyzed were similar between patients with HCV-infection and those with HCV and HBV co-infection. The median survival time was 13.4 (95% CI: 10.7-16.1) years; the median survival time of patients without HCV infection was 14.6 (95% CI: 13.8-15.4) years (p=0.23).
In the era before the availability of new anti-HCV drugs, our experience with HCV-infected renal transplant recipients revealed similar post-transplantation complications, graft and patient survival as those not infected with HCV.
随着可用于治疗丙型肝炎病毒(HCV)的新药的发明,HCV感染的肾移植受者的自然病史即将改变。
分析一个肾移植单位30年活动中HCV感染的肾移植受者的病情演变。
我们研究了1985年至2015年间接受肾移植的1334例患者。
在这1334例患者中,189例(14.2%)HCV血清学呈阳性。60例HCV RNA阳性超过6个月。5例在移植肾仍有功能时死亡;19例移植肾失功并恢复透析。大多数排斥反应发生在移植后的第一年内,且没有导致移植肾立即失功。在移植后期,14例患者出现临床肝病,10例在移植后出现新发糖尿病,4例发生肿瘤,均无肝细胞癌。HCV感染患者与HCV和HBV合并感染患者之间分析的不同变量的结果相似。中位生存时间为13.4年(95%CI:10.7 - 16.1);未感染HCV的患者中位生存时间为14.6年(95%CI:13.8 - 15.4)(p = 0.23)。
在新型抗HCV药物出现之前的时代,我们对HCV感染的肾移植受者的经验显示,其移植后并发症、移植肾和患者生存率与未感染HCV的患者相似。