器官移植传播丙型肝炎的对照研究。新英格兰器官银行丙型肝炎研究小组。

A controlled study of hepatitis C transmission by organ transplantation. The New England Organ Bank Hepatitis C Study Group.

作者信息

Pereira B J, Wright T L, Schmid C H, Levey A S

机构信息

New England Organ Bank, Washington Street, Newton Corner, MA 02158.

出版信息

Lancet. 1995 Feb 25;345(8948):484-7. doi: 10.1016/s0140-6736(95)90583-9.

DOI:10.1016/s0140-6736(95)90583-9

PMID:7532254

Abstract

Hepatitis C virus (HCV) can be transmitted by transplantation of cadaver organs from donors with antibody to HCV (anti-HCV); therefore, transplantation of organs from anti-HCV positive donors to anti-HCV-negative recipients has been discouraged. We have looked at outcomes in recipients of organs from anti-HCV positive and negative donors to determine whether this advice is well-founded. Stored sera from 716 consecutive cadaver organ donors procured by the New England Organ Bank between 1986 and 1990 were tested for anti-HCV by a first-generation ELISA (ELISA1); 13 (1.8%) were positive. 29 recipients who received organs from these donors were the study group. 37 donors were randomly selected from 703 ELISA1-negative cadaver organ donors. 74 recipients of organs from these 37 donors were the control group. Clinical records were reviewed and recipient sera were tested for anti-HCV with a second-generation ELISA (ELISA2), and HCV RNA was tested for by polymerase chain reaction. Median post-transplant follow-up was 42 and 49 months for study and control groups. Post-transplantation prevalence of anti-HCV and HCV RNA was 67% and 96% among recipients from anti-HCV-positive donors, and 20% and 18% among recipients from anti-HCV-negative donors (p < 0.001). Post-transplantation non-A, non-B hepatitis, graft loss, and death were observed in 55%, 52%, and 31% among recipients of organs from anti-HCV-positive donors, and 16%, 53%, and 33% among recipients from anti-HCV-negative donors. In a proportional hazards model, the relative risks for non-A, non-B hepatitis, graft loss, and death among recipients from anti-HCV-positive donors were 4.37 (95% CI 1.97-9.70), 0.93 (0.51-1.70), and 0.89 (0.41-1.93). Transmission of HCV infection by organ transplantation increased the risk of liver disease among recipients. However, after 3.5 years, donor HCV infection did not adversely affect patient survival or graft survival.

摘要

丙型肝炎病毒（HCV）可通过移植来自丙型肝炎病毒抗体阳性（抗-HCV）供体的尸体器官传播；因此，不鼓励将抗-HCV阳性供体的器官移植给抗-HCV阴性受者。我们研究了抗-HCV阳性和阴性供体器官受者的结局，以确定该建议是否有充分依据。对新英格兰器官银行在1986年至1990年间获取的716例连续尸体器官供体的储存血清进行第一代酶联免疫吸附测定（ELISA1）检测抗-HCV；13例（1.8%）呈阳性。29例接受这些供体器官的受者为研究组。从703例ELISA1阴性尸体器官供体中随机选择37例供体。74例接受这37例供体器官的受者为对照组。回顾临床记录，并用第二代酶联免疫吸附测定（ELISA2）检测受者血清中的抗-HCV，通过聚合酶链反应检测HCV RNA。研究组和对照组移植后的中位随访时间分别为42个月和49个月。抗-HCV阳性供体受者中抗-HCV和HCV RNA的移植后患病率分别为67%和96%，抗-HCV阴性供体受者中分别为20%和18%（p<0.001）。抗-HCV阳性供体器官受者中移植后非甲非乙型肝炎、移植物丢失和死亡的发生率分别为55%、52%和31%，抗-HCV阴性供体器官受者中分别为16%、53%和33%。在比例风险模型中，抗-HCV阳性供体受者中非甲非乙型肝炎、移植物丢失和死亡的相对风险分别为4.37（95%可信区间1.97-9.70）、√0.93（0.51-1.70）和0.89（0.41-1.93）。器官移植传播HCV感染增加了受者患肝病的风险。然而，3.5年后，供体HCV感染对患者生存或移植物存活没有不利影响。