Freeman R B, Tran S, Lee Y M, Rohrer R J, Kaplan M M
Division of Transplant Surgery, New England Medical Center/Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
Transplantation. 1996 Feb 27;61(4):542-6. doi: 10.1097/00007890-199602270-00005.
The degree to which immunosuppression and/or rejection influences recurrent hepatitis C (HCV) after liver transplantation (LT) for end-stage HCV cirrhosis remains poorly defined. We quantified serum HCV-RNA in 84 serum samples from 28 anti-HCV-positive patients taken 223 days prior to and up to 1719 days after liver transplantation to determine if cumulative immunosuppression, rejection, or histologic recurrence correlated with HCV-RNA levels. Histologic, serum chemistry, cumulative steroid, and OKT3 and alpha-interferon (INF) dose data were collected at the time of HCV-RNA sampling. Eighteen of 24 evaluable patients (75%) had HCV-RNA detected in their sera after transplant. Eight patients had 14 rejection episodes, 9 patients received OKT3, and 5 were given INF for histologically moderate hepatitis. Five patients died - two of recurrent hepatitis C - and no retransplants were performed for recurrent hepatitis. Of the 23 survivors, 7 have histologic hepatitis - 2 with persistent ascites, and 2 with mild fibrosis. We could show no correlation between HCV-RNA levels and any of the variables examined although a trend toward increasing HCV-RNA levels with increasing numbers of rejection episodes was observed. In addition, histologic recurrence occurred more frequently for patients treated with OKT3. We conclude that the quantity of circulating viral genome is not influenced by immunosuppressive load and does not correlate with laboratory or histologic signs of recurrence. The roles that rejection, and possibly OKT3, play in the recurrence of HCV after liver transplant need further study.
免疫抑制和/或排斥反应对终末期丙型肝炎肝硬化患者肝移植后复发性丙型肝炎（HCV）的影响程度仍不明确。我们对28例抗HCV阳性患者的84份血清样本进行了HCV-RNA定量分析，这些样本采集于肝移植前223天至肝移植后1719天，以确定累积免疫抑制、排斥反应或组织学复发是否与HCV-RNA水平相关。在采集HCV-RNA样本时收集了组织学、血清化学、累积类固醇、OKT3和α干扰素（INF）剂量数据。24例可评估患者中有18例（75%）在移植后血清中检测到HCV-RNA。8例患者发生了14次排斥反应，9例患者接受了OKT3治疗，5例因组织学中度肝炎接受了INF治疗。5例患者死亡，其中2例死于复发性丙型肝炎，未因复发性肝炎进行再次移植。在23名幸存者中，7例有组织学肝炎，2例伴有持续性腹水，2例有轻度纤维化。尽管观察到随着排斥反应次数增加HCV-RNA水平有升高趋势，但我们未能发现HCV-RNA水平与任何检测变量之间存在相关性。此外，接受OKT3治疗的患者组织学复发更频繁。我们得出结论，循环病毒基因组的数量不受免疫抑制负荷的影响，且与复发的实验室或组织学迹象无关。排斥反应以及可能的OKT3在肝移植后HCV复发中所起的作用需要进一步研究。
