Haem J, Berthoux P, Cécillon S, Mosnier J F, Pozzetto B, Berthoux F
Department of Nephrology-Dialysis-Transplantation (NDT), Hôpital Nord, Saint-Etienne, Paris, France.
Nephrol Dial Transplant. 1996;11 Suppl 4:48-51. doi: 10.1093/ndt/11.supp4.48.
The prevalence of HCV infection is high in renal transplantation (RT) patients: 29% in our cohort of 399 RT recipients. The consequences of that infection on the liver have to be carefully assessed. Clinical chronic hepatitis was detected from ALT concentrations (> x 1.5 N) in only 26 patients (22%) with constant (15%) or fluctuating (85%) ALT elevation. Only three of 117 cases developed cirrhosis (3%). No liver cancer was noted. Liver biopsy was performed (mean interval = 60.2 months) in 62 patients with HCV infection alone. We found 26 cases (42%) of chronic active hepatitis (CAH) with a mean Knodell score as low as 6.1 (range: 3-12), a mean activity grade of 4.9, and a fibrosis stage of 1.3. Twelve patients (19%) presented with normal liver pathology and met the criteria of healthy HCV carriers (positive viraemia, normal ALT and normal liver). The rest presented with portal lesions, either inflammation or fibrosis. In addition, patient and graft survival rates did not differ in HCV+ recipients. To conclude, HCV infection did not appear too deleterious for the liver in this cohort of patients. There is therefore no contraindication for HCV-positive recipients to undergo renal transplantation.
丙型肝炎病毒（HCV）感染在肾移植（RT）患者中很常见：在我们的399名肾移植受者队列中，感染率为29%。必须仔细评估这种感染对肝脏的影响。仅在26例（22%）谷丙转氨酶（ALT）浓度升高（>正常上限1.5倍）的患者中检测到临床慢性肝炎，这些患者的ALT升高情况持续（15%）或波动（85%）。117例病例中只有3例（3%）发展为肝硬化。未发现肝癌。对62例单纯HCV感染患者进行了肝活检（平均间隔时间=60.2个月）。我们发现26例（42%）慢性活动性肝炎（CAH）患者，其平均Knodell评分为6.1（范围：3 - 12），平均活动度为4.9，纤维化阶段为1.3。12例患者（19%）肝脏病理正常，符合健康HCV携带者的标准（病毒血症阳性、ALT正常且肝脏正常）。其余患者表现为门静脉病变，包括炎症或纤维化。此外，HCV阳性受者的患者和移植物存活率没有差异。总之，在该患者队列中，HCV感染对肝脏似乎没有太大危害。因此，HCV阳性受者进行肾移植没有禁忌证。
