Caccamo L, Gridelli B, Sampietro M, Melada E, Doglia M, Lunghi G, Corbetta N, Rossi G, Colledan M, Fassati L R, Fiorelli G, Galmarini D
Istituto di Chirurgia Sperimentale e dei Trapianti, Università di Milano, Ospedale Maggiore IRCCS, Italy.
Transpl Int. 1996;9 Suppl 1:S204-9. doi: 10.1007/978-3-662-00818-8_52.
To understand the clinical outcome of hepatitis C virus (HCV) recurrence, data from 35 liver transplant recipients who survived more than 6 months were reviewed. The presence of HCV-RNA was evaluated and genotyping was performed. On the basis of alanine aminotransferase (ALT) levels, patients were sorted into four groups. In 20 patients, a chronic elevation in ALT was found; HCV-RNA detection was positive in 17/17 and the following genotypes were found in 15 of them: 1b in ten patients, 2a in four patients, and 3a in one patient. In 11 patients, ALT levels remained normal throughout follow-up; in nine of them HCV-RNA was positive; HCV genotyping was available in eight patients and identified type 1b in two, type 2a in five, and type 3a in another patient. In two patients, ALT fluctuated above and below the upper limits of normality; type 1b HCV-RNA was found in one of them. In two patients, after an initial period of normality, ALT levels showed an abrupt rise; HCV-RNA was positive and type 1b was identified in both patients. Eight patients developed HCV-related deep jaundice and three of them spontaneously recovered. Progressive hepatic injury occurred in eight patients, six with chronic ALT elevation and two showing a late ALT elevation; genotype 1b was present in seven patients while in one, genotype 3a was found; sub-acute graft failure developed in five of them, leading to death in two and retransplantation in the others; the other three patients are alive with recurrent overt cirrhosis. The 1, 3, and 5 year actuarial survivals were 89%, 79%, and 63% respectively. The 1, 3, and 5 year actuarial risks of progressive graft damage were 6%, 7%, and 15%, respectively. In conclusion, HCV reinfection causes a slow decrease in the long-term patients' survival. Persistent elevation of ALT is more frequently observed in patients with genotype 1b infection.
为了解丙型肝炎病毒（HCV）复发的临床结局，我们回顾了35例存活超过6个月的肝移植受者的数据。评估了HCV-RNA的存在情况并进行了基因分型。根据丙氨酸氨基转移酶（ALT）水平，将患者分为四组。在20例患者中，发现ALT慢性升高；17例中HCV-RNA检测呈阳性，其中15例发现了以下基因型：1b型10例，2a型4例，3a型1例。在11例患者中，整个随访期间ALT水平保持正常；其中9例HCV-RNA呈阳性；8例患者进行了HCV基因分型，其中2例为1b型，5例为2a型，另1例为3a型。在2例患者中，ALT在正常上限上下波动；其中1例发现1b型HCV-RNA。在2例患者中，经过初始正常期后，ALT水平突然升高；HCV-RNA呈阳性，2例均为1b型。8例患者出现了与HCV相关的深度黄疸，其中3例自发恢复。8例患者发生了进行性肝损伤，6例ALT慢性升高，2例ALT后期升高；7例患者为1b型基因型，1例为3a型基因型；其中5例发生亚急性移植物功能衰竭，2例死亡，其余患者接受再次移植；另外3例患者存活，伴有复发性显性肝硬化。1年、3年和5年实际生存率分别为89%、79%和63%。1年、3年和5年移植物进行性损害的实际风险分别为6%、7%和15%。总之，HCV再感染导致长期患者生存率缓慢下降。1b型基因型感染患者更常观察到ALT持续升高。
