Stempel C A, Lake J, Kuo G, Vincenti F
Department of Medicine, University of California, San Francisco 94143.
Transplantation. 1993 Feb;55(2):273-6. doi: 10.1097/00007890-199302000-00008.
There is a high incidence of chronic liver disease in end-stage renal failure patients on dialysis. Hepatitis C virus appears responsible for 80% of posttransfusion hepatitis, and up to 80% of sporadic hepatitis and cryptogenic cirrhosis. Anti-HCV antibodies correlate highly with the presence of active infection. The clinical implications of HCV infection in patients undergoing renal transplantation is unknown. Part I: We undertook a descriptive cross-sectional study of all renal failure patients admitted for kidney transplant between 1/84 and 12/88. Pretransplant sera were assayed for anti-HCV using an ELISA. Patients were divided into anti-HCV-positive (study group) and anti-HCV-negative (controls). Part II: A cohort study was performed with both groups followed from the time of transplantation to the present. Comparisons were made by t tests, chi-square analysis with Yates correction, Mann Whitney test for nonparametric results and multiple regression analysis. Part I: Anti-HCV was present in 76 of 716 sera assayed. There were no differences in sex, age, number of previous transplants, and underlying renal disease. Four variables predicted the presence of anti-HCV: number of blood transfusions; duration on dialysis; i.v. drug abuse, and nonwhite race. Part II: A group of 596 patients was further analyzed. The mean duration of follow-up was not different between the two groups. There were no differences in graft survival, overall mortality, or mortality secondary to liver disease or sepsis. Based on these results, the presence of anti-HCV should not be a contraindication for kidney transplantation.
接受透析治疗的终末期肾衰竭患者中，慢性肝病的发病率很高。丙型肝炎病毒似乎是80%的输血后肝炎、高达80%的散发性肝炎和隐源性肝硬化的病因。抗丙型肝炎病毒抗体与活动性感染的存在高度相关。丙型肝炎病毒感染对接受肾移植患者的临床影响尚不清楚。第一部分：我们对1984年1月至1988年12月期间因肾移植入院的所有肾衰竭患者进行了描述性横断面研究。使用酶联免疫吸附测定法（ELISA）对移植前血清进行抗丙型肝炎病毒检测。患者被分为抗丙型肝炎病毒阳性（研究组）和抗丙型肝炎病毒阴性（对照组）。第二部分：对两组患者从移植时起进行队列研究直至现在。通过t检验、采用Yates校正的卡方分析、对非参数结果进行的Mann Whitney检验和多元回归分析进行比较。第一部分：在检测的716份血清中，有76份存在抗丙型肝炎病毒。在性别、年龄、既往移植次数和基础肾脏疾病方面没有差异。有四个变量可预测抗丙型肝炎病毒的存在：输血次数；透析时间；静脉注射药物滥用和非白人种族。第二部分：对一组596例患者进行了进一步分析。两组的平均随访时间没有差异。在移植物存活率、总死亡率或继发于肝病或败血症的死亡率方面没有差异。基于这些结果，抗丙型肝炎病毒的存在不应成为肾移植的禁忌证。
