Cisterne J M, Rostaing L, Izopet J, Chabannier M H, Baron E, Duffaut M, Durand D, Suc J M
Department of Nephrology, CHU Purpan, Toulouse, France.
Nephrol Dial Transplant. 1996;11 Suppl 4:46-7. doi: 10.1093/ndt/11.supp4.46.
We studied the prevalence of HCV infection in a cohort of 346 patients who received renal transplantation between January 1989 and April 1994. Assessments were made at the time of surgery, one year later and at the last follow-up visit. The hepatic consequences of HCV infection were also studied. The prevalence of HCV infection at the time of surgery was 21.4% (74/346). The risk factors associated with the presence of anti-HCV antibodies were: duration of haemodialysis, the number of transfusions and the number of previous renal transplantations. The incidence of HCV infection was 3% (8/272) and was accompanied by either transient (n = 4) or chronic (n = 3) hepatic cytolysis; five patients underwent liver biopsy which revealed persistent chronic hepatitis (n = 2) or active chronic hepatitis (n = 3). Seroconversion always occurred within one year following transplantation. In the long-term, 91% of HCV+ patients remained viraemic. The HCV genotype was predominantly 1b. Fifty-six per cent (56%) of HCV+ patients had normal ALAT at the time of transplantation, which remained normal on follow-up in two-thirds of cases. After transplantation, 39 HCV+ patients underwent liver biopsy. ALAT were normal in 13 of those; liver biopsy elicited either normal liver (n = 1) or chronic persistent hepatitis (CPH) (n = 8) or chronic active hepatitis (CAH) (n = 4). ALAT were chronically elevated in 26 patients; liver histology revealed: 7 CPH, 19 CAH including 12 cases with bridging fibrosis. No deleterious effect of azathioprine on liver histology was found. Lastly, four patients were co-infected with HBV: all had elevated ALAT; liver biopsy always revealed severe chronic active hepatitis. Post-transplantation hepatitis C is a worrying problem. Liver enzymes are not correlated with the severity of histological disorders, which are frequent. Interferon-alpha therapy should be proposed to HCV+ patients before renal transplantation.
我们研究了1989年1月至1994年4月间接受肾移植的346例患者队列中丙型肝炎病毒（HCV）感染的患病率。在手术时、术后一年以及最后一次随访时进行评估。还研究了HCV感染的肝脏后果。手术时HCV感染的患病率为21.4%（74/346）。与抗HCV抗体存在相关的危险因素为：血液透析时间、输血次数和既往肾移植次数。HCV感染的发生率为3%（8/272），伴有短暂性（n = 4）或慢性（n = 3）肝细胞溶解；5例患者接受了肝活检，结果显示为持续性慢性肝炎（n = 2）或活动性慢性肝炎（n = 3）。血清转换总是发生在移植后一年内。长期来看，91%的HCV阳性患者仍有病毒血症。HCV基因型主要为1b型。56%的HCV阳性患者在移植时丙氨酸转氨酶（ALAT）正常，三分之二的病例在随访中仍保持正常。移植后，39例HCV阳性患者接受了肝活检。其中13例ALAT正常；肝活检结果为正常肝脏（n = 1）、慢性持续性肝炎（CPH）（n = 8）或慢性活动性肝炎（CAH）（n = 4）。26例患者的ALAT长期升高；肝脏组织学显示：7例CPH，19例CAH，其中12例有桥接纤维化。未发现硫唑嘌呤对肝脏组织学有有害影响。最后，4例患者合并感染乙型肝炎病毒（HBV）：所有患者的ALAT均升高；肝活检总是显示为严重的慢性活动性肝炎。移植后丙型肝炎是一个令人担忧的问题。肝酶与常见的组织学病变严重程度不相关。应在肾移植前对HCV阳性患者建议使用α干扰素治疗。
