Randhawa P S, Demetris A J
Division of Transplant Pathology, Presbyterian University Hospital, Pittsburgh, Pennsylvania, USA.
Pathol Annu. 1995;30 Pt 2:203-26.
HCV infection occurs de novo in 10 percent of liver transplant recipients, reflecting transmission of the virus by the donor organ or blood transfusions. A much more common scenario, however, is recurrent allograft infection following liver transplantation for HCV-associated end-stage liver disease. Removal of the native liver in this clinical setting does not lead to eradication of infection. The virus persists in the blood and subsequently replicates under immunosuppression, resulting in a positive PCR test for HCV in most patients following transplantation. Clinically significant hepatitis develops in 44 percent of patients at the University of Pittsburgh, but the reported incidence worldwide varies from 32 to 100 percent. Most patients show mild to moderately active disease, but in our experience, approximately 10 percent of patients develop progressive liver damage evolving into cirrhosis. The 3-year graft survival at Pittsburgh after a mean follow up period of 20 +/- 14 months is 68 percent, which compares with 82 percent graft survival for patients transplanted for diseases other than HCV. The long-term consequences of allograft HCV infection are not yet completely defined, but HCV-associated cirrhosis remains a valid indication for liver transplantation.
10%的肝移植受者会新发丙型肝炎病毒（HCV）感染，这反映了病毒通过供体器官或输血传播。然而，更为常见的情况是，因HCV相关终末期肝病接受肝移植后发生移植物反复感染。在此临床情况下，切除原肝并不能根除感染。病毒持续存在于血液中，随后在免疫抑制状态下复制，导致大多数移植后患者的HCV聚合酶链反应（PCR）检测呈阳性。匹兹堡大学44%的患者会发生具有临床意义的肝炎，但全球报道的发病率在32%至100%之间。大多数患者表现为轻度至中度活动性疾病，但根据我们的经验，约10%的患者会出现进行性肝损伤并发展为肝硬化。在匹兹堡，平均随访20±14个月后，3年移植物存活率为68%，而因非HCV疾病接受移植的患者移植物存活率为82%。移植物HCV感染的长期后果尚未完全明确，但HCV相关肝硬化仍然是肝移植的一个有效指征。
