Bernard P H, Malavialle P, Le Bail B, Carles J, Dumas F, Richard L, Winnock S, Couzigou P, Bioulac-Sage P, Balabaud C
Unité de Transplantation Hépatique, Hôpital Pellegrin, Bordeaux.
Gastroenterol Clin Biol. 1995 Aug-Sep;19(8-9):692-7.
HCV cirrhosis is one of the major indications for liver transplantation. HCV recurrence rate is high but long term development to cirrhosis seems to be rare. This study included 28 patients with HCV infection (HCV RNA in blood, histologic lesions highly suggestive or compatible with HCV infection).
Twenty-one out of the 28 patients were transplanted for hepatic chronic liver disease associated with HCV infection (reinfection), whereas only 7 out of 94 transplanted patients (7.4%) without pre-transplant HCV infection ("de novo" infection). Patients were followed clinically and histologically for a mean period of 26.8 months (range: 3-56). Of 26 patients with a good histological evaluation, 24 (92.3%) had chronic hepatitis: 7 with mild activity, 17 with moderate activity, 7 of whom had bridging fibrosis. Two patients had unusual features with associated lesions (necrotic hepatitis and chronic rejection in one case, acute hepatitis associated with CMV infection in the other).
This study confirms the high prevalence of HCV recurrence, as well as the "de novo" infection risk, and suggests caution concerning long term prognosis.
丙型肝炎病毒（HCV）肝硬化是肝移植的主要适应证之一。HCV复发率很高，但长期发展为肝硬化似乎很少见。本研究纳入了28例HCV感染患者（血液中检测到HCV RNA，组织学病变高度提示或符合HCV感染）。
28例患者中有21例因与HCV感染相关的慢性肝病（再感染）接受了移植，而94例移植前无HCV感染的患者中只有7例（7.4%）发生了“新发”感染。对患者进行了平均26.8个月（范围：3 - 56个月）的临床和组织学随访。在26例组织学评估良好的患者中，24例（92.3%）患有慢性肝炎：7例为轻度活动，17例为中度活动，其中7例有桥接纤维化。2例患者有不寻常特征并伴有相关病变（1例为坏死性肝炎和慢性排斥反应，另1例为与巨细胞病毒感染相关的急性肝炎）。
本研究证实了HCV复发的高发生率以及“新发”感染风险，并提示应谨慎对待长期预后。
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