Bouthot B A, Murthy B V, Schmid C H, Levey A S, Pereira B J
Division of Nephrology, New England Medical Center, Boston, Massachusetts 02111, USA.
Transplantation. 1997 Mar 27;63(6):849-53. doi: 10.1097/00007890-199703270-00010.
Hepatitis C virus (HCV) infection causes slowly progressive liver disease. Therefore, the full impact of HCV infection after transplantation may require 5-10 years of follow-up.
We have previously reported the effect of HCV infection, acquired from the donor (study 1) or acquired before transplantation (study 2), on the incidence of liver disease, and on patient and graft survival with a median follow-up of 3-5 years. In study 1, we compared 24 recipients of organs from donors who were positive to antibody to HCV (anti-HCV) to 74 recipients of organs from anti-HCV-negative donors. In study 2, we compared 23 anti-HCV-positive recipients to 80 anti-HCV-negative recipients of kidneys from anti-HCV-negative donors. In this report, we extend the median follow-up period for patient and graft survival to 6-7 years, and discuss the implications of our finding on policies for organ procurement.
In study 2, after extended follow-up, there continued to be no significant difference between groups with respect to graft loss, but mortality remained significantly higher among recipients with anti-HCV before transplantation. Compared with recipients without anti-HCV before transplantation, the relative risk of graft loss among recipients with anti-HCV before transplantation was 1.30 (0.66-2.58), the relative risk of death was 2.60 (1.15-5.90), and the relative risk of death due to sepsis was 6.30 (1.99-20). In study 1, after extended follow-up, there continued to be no significant differences between groups, with respect to graft loss or death. Compared with recipients of organs from anti-HCV-negative donors, the relative risk of graft loss among recipients of organs from anti-HCV-positive donors was 0.95 (0.54-1.67), and the relative risk of death was 1.00 (0.49-2.02).
The two studies presented in this report provide an apparent paradox, with respect to the impact of HCV infection acquired at the time of transplantation versus before transplantation on posttransplantation clinical outcomes. However, the increased mortality among recipients who acquired HCV infection before transplantation, but not among recipients who acquired HCV at the time of transplantation, could be explained by the longer duration of HCV infection in the former group. These findings are consistent with the known slowly progressive nature of HCV infection. However, in the absence of definitive evidence for an adverse effect on patient or graft survival, we believe that the decision to accept a kidney from an anti-HCV-positive donor should be made by the patient, after discussion with the treating physician.
丙型肝炎病毒（HCV）感染会导致肝脏疾病缓慢进展。因此，移植后HCV感染的全面影响可能需要5至10年的随访。
我们之前曾报道过从供体获得（研究1）或移植前获得（研究2）的HCV感染对肝脏疾病发病率以及患者和移植物存活情况的影响，中位随访时间为3至5年。在研究1中，我们将24名接受抗HCV抗体阳性供体器官的受者与74名接受抗HCV阴性供体器官的受者进行了比较。在研究2中，我们将23名抗HCV阳性受者与80名接受来自抗HCV阴性供体肾脏的抗HCV阴性受者进行了比较。在本报告中，我们将患者和移植物存活的中位随访期延长至6至7年，并讨论了我们的发现对器官获取政策的影响。
在研究2中，延长随访后，两组在移植物丢失方面仍无显著差异，但移植前抗HCV的受者死亡率仍然显著更高。与移植前无抗HCV的受者相比，移植前抗HCV的受者移植物丢失的相对风险为1.30（0.66 - 2.58），死亡的相对风险为2.60（1.15 - 5.90），因败血症死亡的相对风险为6.30（1.99 - 20）。在研究1中，延长随访后，两组在移植物丢失或死亡方面仍无显著差异。与接受抗HCV阴性供体器官的受者相比，接受抗HCV阳性供体器官的受者移植物丢失的相对风险为0.95（0.54 - 1.67），死亡的相对风险为1.00（0.49 - 2.02）。
本报告中的两项研究在移植时获得的HCV感染与移植前获得的HCV感染对移植后临床结局的影响方面呈现出明显的矛盾。然而，移植前获得HCV感染的受者死亡率增加，而移植时获得HCV感染的受者死亡率未增加，这可以用前一组HCV感染持续时间更长来解释。这些发现与已知的HCV感染缓慢进展的性质一致。然而，在缺乏对患者或移植物存活有不利影响的确切证据的情况下，我们认为是否接受抗HCV阳性供体的肾脏应由患者在与主治医生讨论后做出决定。
