丙型肝炎病毒血清学阳性肾移植受者的肝脏疾病风险。

Risk of liver disease in HCV-seropositive kidney transplant recipients.

作者信息

Rohr M S, Lesniewski R R, Rubin C A, Johnson R G, Heise E R, McDonald J C, Adams P L

机构信息

Bowman Gray School of Medicine, Winston-Salem, North Carolina.

出版信息

Ann Surg. 1993 May;217(5):512-6; discussion 516-7. doi: 10.1097/00000658-199305010-00011.

DOI:10.1097/00000658-199305010-00011

PMID:8387764

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1242833/

Abstract

OBJECTIVE

This study determined whether renal allograft recipients with antibodies to hepatitis C virus (HCV) at the time of transplantation experienced increased morbidity or mortality from hepatitis, liver disease, or hepatocellular carcinoma compared with patients without anti-HCV.

SUMMARY BACKGROUND DATA

Chronic liver disease is a cause of significant morbidity and mortality after kidney transplantation and the contribution of HCV to this problem has not been determined. The recent characterization of the HCV genome has resulted in the development of screening tests for antibody to HCV, allowing the identification of end-stage renal disease patients with anti-HCV who are candidates for transplantation. The risk to these patients for the development of hepatic complications after subsequent transplantation is unknown.

METHODS

Archived sera obtained from 163 kidney transplant recipients at the time of transplantation were tested for anti-HCV using the Abbott HCV 2.0 second-generation test system. Sera containing anti-HCV were further analyzed for reactivity against specific HCV recombinant proteins, including core, NS3 (c33c), and NS4 (c100-3), to determine whether a pattern could be identified in patients with hepatic complications. The follow-up of all patients was current (mean length of follow-up was 33 months) to identify patients with hepatic complications. All patients had previously been tested for HBSAg.

RESULTS

Twenty-nine patients (18%) had anti-HCV and three (1.8%) had HBSAg. Forty-five patients (28% of total) had transient elevations of AST or ALT without subsequent evidence of liver disease. Three patients had a syndrome of acute hepatitis. Chronic liver disease developed in only six patients (3.6%) after transplantation. Four had anti-HCV only, one had HBSAg only, and one was positive for both. However, of the 29 patients with anti-HCV, chronic liver disease developed in 5 (17%), including 1 patient who was positive for HBSAg. No patient had hepatocellular carcinoma.

CONCLUSIONS

Perturbations of liver function were common in the kidney transplant recipients studied, most were self-limited, and few were associated with evidence of viral hepatitis. The risk of developing

摘要

目的

本研究旨在确定肾移植受者在移植时若有丙型肝炎病毒（HCV）抗体，与无抗-HCV的患者相比，其因肝炎、肝病或肝细胞癌导致的发病率或死亡率是否增加。

总结背景数据

慢性肝病是肾移植后发病和死亡的一个重要原因，而HCV对这一问题的影响尚未明确。HCV基因组的最新特征促使了抗-HCV筛查试验的发展，从而能够识别出有抗-HCV的终末期肾病患者作为移植候选者。这些患者在后续移植后发生肝脏并发症的风险尚不清楚。

方法

使用雅培HCV 2.0第二代检测系统对163例肾移植受者移植时采集的存档血清进行抗-HCV检测。对含有抗-HCV的血清进一步分析其对特定HCV重组蛋白（包括核心蛋白、NS3（c33c）和NS4（c100-3））的反应性，以确定能否在有肝脏并发症的患者中识别出一种模式。对所有患者的随访是最新的（平均随访时间为33个月），以确定有肝脏并发症的患者。所有患者之前均已检测过乙肝表面抗原（HBSAg）。

结果

29例患者（18%）有抗-HCV，3例（1.8%）有HBSAg。45例患者（占总数的28%）出现AST或ALT短暂升高，但随后无肝病证据。3例患者出现急性肝炎综合征。移植后仅6例患者（3.6%）发生慢性肝病。4例仅有抗-HCV，1例仅有HBSAg，1例两者均为阳性。然而，在29例有抗-HCV的患者中，5例（17%）发生慢性肝病，其中1例HBSAg阳性。无患者发生肝细胞癌。