Gugenheim J, Baldini E, Ouzan D, Mazza D, Saint-Paul M C, Goubaux B, Mouiel J
Service de Chirurgie Digestive et de Transplantation Hépatique, Hôpital Saint-Roch, Université de Nice.
Gastroenterol Clin Biol. 1996;20(10):730-5.
Hepatitis C virus recurrence is frequent after orthotopic liver transplantation. The aim of this study was to evaluate the clinical, biological, and histological characteristics of recurrence.
One hundred and ten patients (91 males, mean age 49 years) with liver transplantation were followed up for more than 1 year (mean: 26 months, range: 12-71). Hepatitis C virus serologic 2nd generation tests were performed before and every 3 months after transplantation in all patients. Serum RNA was detected every 6 months after transplantation by polymerase chain reaction. A percutaneous liver biopsy was performed every year in all patients and in case of abnormal biological liver tests.
In 44 patients (40%), hepatitis C virus serology was positive before transplantation, and was unchanged after transplantation. In this group histologic chronic hepatitis was observed in 35 patients (79.5%). The mean Knodell score was 8.4 +/- 2.3, associated with an increase in serum aminotransferases (> twice the upper limit of normal) in 26 cases (74.3%) and with serum RNA in 33 cases (94.3%). The Knodell score was not significantly higher 2 years or more after transplantation than before (9.5 +/- 3.9 vs 7.2 +/- 3.5). In 66 patients with negative hepatitis C virus serology before transplantation, no changes were noted after transplantation. In this group, histologic chronic hepatitis was found in 14 cases (21.2%) associated with serum hepatitis C virus RNA in 7 cases. Actuarial survival rates of the two groups were 97.1% and 91.2% at 2 years, and 93.5% and 86.7% at 5 years, respectively. No death clearly related to hepatitis C virus recurrence was observed.
Hepatitis C virus recurrence after liver transplantation is frequently associated with chronic hepatitis, and a progressive increase in liver lesions. Nevertheless, the 5-year survival rates was not different in these patients compared to patients with negative hepatitis C virus serology before transplantation.
原位肝移植后丙型肝炎病毒复发很常见。本研究的目的是评估复发的临床、生物学和组织学特征。
110例肝移植患者（91例男性，平均年龄49岁）随访超过1年（平均：26个月，范围：12 - 71个月）。所有患者在移植前及移植后每3个月进行丙型肝炎病毒第二代血清学检测。移植后每6个月通过聚合酶链反应检测血清RNA。所有患者每年进行经皮肝活检，肝功能检查异常时也进行活检。
44例患者（40%）移植前丙型肝炎病毒血清学呈阳性，移植后无变化。在该组中，35例患者（79.5%）观察到组织学慢性肝炎。平均Knodell评分为8.4±2.3，26例（74.3%）患者血清转氨酶升高（>正常上限两倍），33例（94.3%）患者血清RNA升高。移植后2年或更长时间的Knodell评分与移植前相比无显著升高（9.5±3.9对7.2±3.5）。66例移植前丙型肝炎病毒血清学阴性的患者，移植后无变化。在该组中，14例患者（21.2%）发现组织学慢性肝炎，7例患者血清丙型肝炎病毒RNA阳性。两组患者2年时的精算生存率分别为97.1%和91.2%，5年时分别为93.5%和86.7%。未观察到明显与丙型肝炎病毒复发相关的死亡。
肝移植后丙型肝炎病毒复发常与慢性肝炎及肝脏病变的逐渐加重相关。然而，与移植前丙型肝炎病毒血清学阴性的患者相比，这些患者的5年生存率并无差异。
