Widell A, Månsson S, Persson N H, Thysell H, Hermodsson S, Blohme I
Department of Medical Microbiology, Malmö University Hospital, Sweden.
Transplantation. 1995 Oct 15;60(7):642-7. doi: 10.1097/00007890-199510150-00004.
Hepatitis C virus (HCV) genotypes, determined by polymerase chain reaction with type-specific primers, were studied in 5 already HCV-infected patients receiving kidneys from HCV-infected cadaver donors. Three patients were investigated retrospectively using stored pre- and posttransplantation sera and followed 18-28 months after transplantation. Two recipients with HCV genotype 2b infection had received kidneys from 1 genotype 3a-infected donor. In 1 recipient, HCV 2b was replaced by the donor's type; in the other recipient, a prolonged mixed infection of 3a and 2b occurred. Persistent alanine aminotransferase (ALT) elevation (3- to 5-fold) appeared in both patients. The third patient, also HCV 2b infected when transplanted with an HCV 3a-infected kidney, remained infected with HCV 2b only. Two patients, one with HCV genotype 1b and the other with genotype 3a, were followed prospectively with frequent bleeds (initially biweekly) and genotyping over 14 months after they had received kidneys from 1 HCV genotype 1a-infected donor. The HCV 1b-infected recipient remained infected with 1b only and had minimal biochemical signs of liver injury. In the other recipient, mixed infection of 3a and 1a appeared at week 3 and persisted for several weeks, until only genotype 1a could be detected. This patient had elevated ALT levels before transplantation. After onset of mixed infection, ALT levels increased further for several weeks, and returned to pretransplantation levels when only HCV 1a was found. HCV-infected kidneys transplanted into HCV-infected recipients gave 3 different virus patterns. Most patients benefitted in the short term, but some super-infected patients experienced increased liver damage.
采用型特异性引物通过聚合酶链反应确定丙型肝炎病毒（HCV）基因型，对5例已感染HCV且接受来自HCV感染尸体供体肾脏的患者进行了研究。对3例患者进行回顾性研究，使用储存的移植前后血清，并在移植后随访18 - 28个月。2例感染HCV 2b基因型的受者接受了来自1例感染3a基因型供者的肾脏。在1例受者中，HCV 2b被供者的基因型取代；在另1例受者中，出现了3a和2b的长期混合感染。两名患者均出现持续性丙氨酸转氨酶（ALT）升高（3至5倍）。第3例患者在移植感染HCV 3a的肾脏时也感染了HCV 2b，仅持续感染HCV 2b。对2例患者进行前瞻性随访，1例感染HCV 1b基因型，另1例感染3a基因型，在接受来自1例感染HCV 1a基因型供者的肾脏后，频繁采血（最初每两周一次）并进行基因分型，随访14个月。感染HCV 1b的受者仅持续感染1b，肝脏损伤的生化指标轻微。在另1例受者中，3a和1a的混合感染在第3周出现并持续数周，直到仅能检测到基因型1a。该患者移植前ALT水平升高。混合感染开始后，ALT水平进一步升高数周，当仅发现HCV 1a时恢复到移植前水平。移植到HCV感染受者体内的HCV感染肾脏出现了3种不同的病毒模式。大多数患者短期内受益，但一些重叠感染的患者肝脏损伤加重。
