Rao K V, Ma J
Department of Medicine, Hennepin County Medical Center and University of Minnesota Medical School, Minneapolis, USA.
Transplantation. 1996 Dec 27;62(12):1765-9. doi: 10.1097/00007890-199612270-00013.
To assess the impact of chronic viral hepatitis on host immune response, we analyzed the incidence of acute rejection and the frequency of infections in 86 patients infected with hepatitis B and C viruses and had developed clinical evidence of chronic liver disease and 1283 control patients who were transplanted at our center during the same period, but had no evidence of chronic viral hepatitis. To compare the mean number of rejections and the mean number of infections between the two groups, we used multivariate linear regression analysis, which allowed us to adjust simultaneously for the effects of 10 other risk variables with potential impact on graft rejection and posttransplant infection. During a mean follow up of 5.3+/-5.2 years, 62% of hepatitis patients and 54% of control patients had experienced an acute rejection (P=NS). The mean rejections/patient in the hepatitis group was 1.3+/-0.14 versus 1.03+/-0.03 in control (P=NS). In the linear regression analysis, the number of acute rejections in the hepatitis group was 0.16 higher than in control (P=NS). With reference to infection, 84% of hepatitis patients experienced an infectious complication in the posttransplant period, compared with 75% in the control (P=0.05). The mean number of infections/patient was 5.7+/-0.73 in the hepatitis group compared with 3.9+/-0.14 in the control group (P=0.002). The linear regression model had shown that the hepatitis group had a relative increase of 1.18 infections/pt, compared with control. Of the different sites of infection, the hepatitis group had a significant increase in bloodstream (0.48+/-0.08 vs. 0.25+/-0.02) P=0.003; pulmonary (0.60+/-0.09 vs. 0.38+/-0.03) P=0.03; and CNS infections (0.08+/-0.03 vs. 0.02+/-0.004) P=0.05 compared with control. Among the different microorganisms causing infection, the hepatitis patients had a significant increase in gram negative bacterial infections compared with the control group (74% vs. 61%) P=0.04. Our data suggest that chronic viral hepatitis is associated with a significant increase in overall infections, and that of potentially fatal infections involving CNS, lungs and bloodstream. Since there is no significant increase in the rate of graft rejection, one could consider a cautious reduction in the doses of maintenance immunosuppressive agents in renal transplant patients with chronic viral hepatitis. The reduced immunosuppression may in turn lower the death rate from sepsis and progressive hepatic failure.
为评估慢性病毒性肝炎对宿主免疫反应的影响，我们分析了86例感染乙型和丙型肝炎病毒且已出现慢性肝病临床证据的患者以及1283例同期在本中心接受移植但无慢性病毒性肝炎证据的对照患者的急性排斥反应发生率和感染频率。为比较两组之间的排斥反应平均数和感染平均数，我们使用了多元线性回归分析，这使我们能够同时调整其他10个对移植排斥和移植后感染有潜在影响的风险变量的作用。在平均5.3±5.2年的随访期间，62%的肝炎患者和54%的对照患者经历了急性排斥反应（P=无显著性差异）。肝炎组患者的平均排斥反应次数为1.3±0.14次，而对照组为1.03±0.03次（P=无显著性差异）。在线性回归分析中，肝炎组的急性排斥反应次数比对照组高0.16次（P=无显著性差异）。关于感染，84%的肝炎患者在移植后出现感染并发症，而对照组为75%（P=0.05）。肝炎组患者的平均感染次数为5.7±0.73次，而对照组为3.9±0.14次（P=0.002）。线性回归模型显示，与对照组相比，肝炎组的感染相对增加量为1.18次/患者。在不同的感染部位中，肝炎组的血流感染（0.48±0.08对0.25±0.02）P=0.003；肺部感染（0.60±0.09对0.38±0.03）P=0.03；中枢神经系统感染（0.08±0.03对0.02±0.004）P=0.05均显著高于对照组。在引起感染的不同微生物中，与对照组相比，肝炎患者的革兰氏阴性菌感染显著增加（74%对61%）P=0.04。我们的数据表明，慢性病毒性肝炎与总体感染显著增加相关，尤其是与涉及中枢神经系统、肺部和血流的潜在致命感染相关。由于移植排斥率没有显著增加，对于患有慢性病毒性肝炎的肾移植患者，可以考虑谨慎降低维持性免疫抑制剂的剂量。免疫抑制的降低可能反过来降低败血症和进行性肝衰竭的死亡率。
