Johnson M W, Washburn W K, Freeman R B, FitzMaurice S E, Dienstag J, Basgoz N, Jenkins R L, Cosimi A B
Transplantation Unit, Massachusetts General Hospital, Boston, USA.
Arch Surg. 1996 Mar;131(3):284-91. doi: 10.1001/archsurg.1996.01430150062013.
To study the outcomes of patients who underwent liver transplantation for the primary diagnosis of chronic active hepatitis secondary to hepatitis C virus (HCV).
Retrospective review within a university medical center.
Seventy-four adult recipients who received 78 orthotopic liver allografts for the primary diagnosis of chronic active hepatitis secondary to HCV between January 1990 and December 1994. Sixty-seven patients (91%) survived more than 2 months and were analyzed further for recurrent HCV infection.
Recurrence of HCV infection, hepatitis, or cirrhosis and survival rates for patients who were undergoing orthotopic liver transplantation for chronic active hepatitis secondary to HCV.
Actuarial survival rates for the entire group were 79.3%, 70.9%, and 64.5% at 1,2, and 3 years, respectively. Four patients (5% underwent retransplantation with an actuarial survival rate of 14.3% at 1 year (P<.05). Thirty-eight patients (57%) had evidence of posttransplant HCV infection, 31 patients (46%) showed histologic evidence of viral hepatitis, and 11 patients (16%) experienced portal fibrosis or cirrhosis. Seven (33%) of the deaths and all retransplantations were secondary to recurrent HCV infection. There were no significant differences in age, sex, United Network of Organ Sharing status, associated diagnoses, intraoperative packed red blood cell requirements, OKT3 use, or 1-, 2-, and 3-year survival rates in the recurrent vs nonrecurrent HCV infection groups. A higher incidence of posttransplant cirrhosis was observed in patients who were treated with tacrolimus (FK 506) (31.8% vs 8.9%, P<.05). Twenty-one patients (70%) received interferon alfa antiviral therapy with a significant benefit in the liver function test results during therapy (P<.01).
Despite recurrence of HCV infection in most patients after transplantation, survival following primary orthotopic liver transplantation for chronic active hepatitis secondary to HCV infection remains favorable, and these patients should continue to be candidates for liver transplantation. In contrast, survival following retransplantation for HCV infection is poor and should be reconsidered. There is an apparent association between the intensity of immunosuppression and recurrent HCV infection and cirrhosis that warrants continued evaluation. Interferon therapy appears to afford benefit to patients in whom recurrent HCV hepatitis develops after transplantation.
研究因丙型肝炎病毒（HCV）继发的慢性活动性肝炎而接受肝移植患者的预后情况。
在一所大学医学中心进行回顾性研究。
1990年1月至1994年12月期间，74例成年受者因HCV继发的慢性活动性肝炎接受了78次原位肝移植。67例患者（91%）存活超过2个月，并进一步分析复发性HCV感染情况。
因HCV继发的慢性活动性肝炎接受原位肝移植患者的HCV感染复发、肝炎或肝硬化情况以及生存率。
整个组1年、2年和3年的精算生存率分别为79.3%、70.9%和64.5%。4例患者（5%）接受了再次移植，1年精算生存率为14.3%（P<0.05）。38例患者（57%）有移植后HCV感染证据，31例患者（46%）有病毒性肝炎的组织学证据，11例患者（16%）出现门静脉纤维化或肝硬化。7例死亡患者（33%）和所有再次移植患者均继发于复发性HCV感染。复发性与非复发性HCV感染组在年龄、性别、器官共享联合网络状态、相关诊断、术中红细胞压积需求情况、OKT3使用情况或1年、2年和3年生存率方面无显著差异。接受他克莫司（FK 506）治疗的患者移植后肝硬化发生率较高（31.8%对8.9%，P<0.05）。21例患者（70%）接受了干扰素α抗病毒治疗，治疗期间肝功能检查结果有显著改善（P<0.01）。
尽管大多数患者移植后会出现HCV感染复发，但因HCV感染继发的慢性活动性肝炎接受原位肝移植后的生存率仍然良好，这些患者应继续作为肝移植的候选者。相比之下，因HCV感染进行再次移植后的生存率较差，应重新考虑。免疫抑制强度与复发性HCV感染和肝硬化之间存在明显关联，值得持续评估。干扰素治疗似乎对移植后发生复发性HCV肝炎患者有益。
