Tesi R J, Waller K, Morgan C J, Delaney S, Elkhammas E A, Henry M L, Ferguson R M
Department of Surgery, Ohio State University, Columbus 43210.
Transplantation. 1994 Mar 27;57(6):826-31. doi: 10.1097/00007890-199403270-00010.
The use of cadaveric organ donors with positive serologic tests for hepatitis C (HCV) has caused considerable debate. We have reviewed the clinical course of 43 EIA1 HCV-negative recipients who received kidney transplants from EIA1 HCV-positive donors (Study). We have attempted to define the rate of HCV-RNA transmission and to determine the frequency of HCV disease transmission as determined by abnormalities in liver function tests. Viral transmission was assessed using serologic assays for HCV antibody formation (EIA1, EIA2, and Matrix--an automated multiple antigen immunoblot assay) and with PCR testing for the presence of HCV-RNA on recipient sera. Liver function was followed longitudinally in the Study patients and compared with a group of 103 kidney recipients of organs from EIA1 HCV-negative donors (Control). Of the Study patients, 56% became PCR-positive for HCV-RNA, suggesting the transmission of HCV-RNA from the HCV-positive donor. Interpretation of serologic tests for HCV was complex. Currently available first (EIA1) and second (EIA2) generation serologic assays were always negative. The multiple antigen immunoblots assay (Matrix) had a high positive predictive value (93%) for the presence of HCV-RNA transmission, but one-third of Matrix-negative Study patients were PCR-positive (sensitivity = 66%). Currently, only 38% of recipients have HCV-RNA, suggesting that the virus may have been cleared by one-third of Study recipients who had circulating virus. Traditional tests of liver function (ALT, AST, AP, and GGT) were of limited use in predicting HCV-RNA transmission. Average AST, AP, and GGT were similar in the two groups. Average ALT was increased (93 I/U and 47 I/U) in Study and Control patients, respectively, but this difference was not significant. Episodes of abnormal liver function (ALT 60-99 IU for > or = 14 days) occurred in 22% of Study and 10% of Control patients (P = NS) and lasted longer in Study compared with Control patients (301 vs. 138 days; P < 0.02). Hepatitis (ALT > or = 100 IU for > 14 days) occurred with an equal frequency (6.5%) in both groups. The presence of HCV-RNA did not predict episodes of abnormal liver function. Fulminant hepatitis or rapidly progressive cirrhosis did not occur in the recipients of organs from HCV-positive donors. These data demonstrate a high efficiency of transfer of HCV-RNA by kidney transplantation from an HCV-positive donor to an HCV-negative recipient. A majority of the patients have asymptomatic HCV infection.(ABSTRACT TRUNCATED AT 400 WORDS)
使用丙型肝炎病毒（HCV）血清学检测呈阳性的尸体器官供体引发了诸多争议。我们回顾了43例酶免疫分析1（EIA1）HCV阴性受者的临床病程，这些受者接受了来自EIA1 HCV阳性供体的肾移植（研究）。我们试图确定HCV - RNA传播率，并通过肝功能检查异常来确定HCV疾病传播的频率。使用针对HCV抗体形成的血清学检测（EIA1、EIA2和基质——一种自动化多抗原免疫印迹检测）以及对受者血清中HCV - RNA存在情况进行PCR检测来评估病毒传播。对研究患者的肝功能进行纵向跟踪，并与一组103例接受来自EIA1 HCV阴性供体器官的肾移植受者（对照组）进行比较。在研究患者中，56%的人HCV - RNA PCR检测呈阳性，提示HCV - RNA从HCV阳性供体传播。HCV血清学检测的解读很复杂。目前可用的第一代（EIA1）和第二代（EIA2）血清学检测始终为阴性。多抗原免疫印迹检测（基质）对HCV - RNA传播的存在具有较高的阳性预测价值（93%），但三分之一基质检测为阴性的研究患者PCR检测呈阳性（敏感性 = 66%）。目前，只有38%的受者有HCV - RNA，这表明三分之一有循环病毒的研究受者可能已清除病毒。传统的肝功能检测（谷丙转氨酶、谷草转氨酶、碱性磷酸酶和γ-谷氨酰转肽酶）在预测HCV - RNA传播方面作用有限。两组的平均谷草转氨酶、碱性磷酸酶和γ-谷氨酰转肽酶相似。研究组和对照组患者的平均谷丙转氨酶分别升高（93国际单位和47国际单位），但这种差异不显著。肝功能异常发作（谷丙转氨酶60 - 99国际单位持续≥14天）在22%的研究患者和10%的对照患者中出现（P = 无显著性差异），且研究组患者持续时间比对照组更长（301天对138天；P < 0.02）。肝炎（谷丙转氨酶≥100国际单位持续>14天）在两组中出现频率相同（6.5%）。HCV - RNA的存在并不能预测肝功能异常发作。HCV阳性供体器官的受者未发生暴发性肝炎或快速进展性肝硬化。这些数据表明通过肾移植从HCV阳性供体向HCV阴性受者转移HCV - RNA的效率很高。大多数患者有无症状HCV感染。（摘要截选至400字）
