Stehman-Breen C O, Psaty B M, Emerson S, Gretch D, Bronner M, Marsh C, Davis C L
Department of Medicine, University of Washington, Seattle 98195, USA.
Transplantation. 1997 Jul 27;64(2):281-6. doi: 10.1097/00007890-199707270-00018.
Although most studies have not demonstrated decreased patient or graft survival in kidney-alone allograft recipients infected with hepatitis C virus (HCV), the impact of HCV infection on patient and graft survival in HCV-infected kidney-pancreas recipients has not been studied.
We undertook a retrospective cohort analysis of 137 kidney-pancreas transplant recipients who were transplanted between January 1989 and May 1996. HCV infection was determined by a positive polymerase chain reaction. Relative risk of death and graft failure was calculated using the Cox proportional hazards model with time-dependent covariates. Relative risks were adjusted (aRR) to control for the number of OKT3-treated rejections and cytomegalovirus status of the recipient at the time of transplantation.
Mean length of follow-up was 30.4 months in the HCV-infected patients compared with 31.7 months in noninfected patients. Seven (5.1%) patients were infected with HCV before transplant, one (1%) relapsed after transplantation, and four (2.9%) acquired the infection after transplantation. The HCV-infected group had a 3.7-fold (95% confidence interval [CI], 1.0-13.5) increased risk of death after transplant compared with the HCV-negative group, with an aRR of 5.5 (95% CI, 1.5-20.0). Death in the HCV-infected group (n=3) was generally the result of liver failure and sepsis, whereas death for those in the uninfected group (n=11) was primarily of cardiovascular origin. Patients infected with HCV were 3.4-fold (95% CI, 1.1-10.1) more likely to develop kidney graft failure than HCV-negative patients with an aRR of 5.1 (95% CI, 1.7-15.4). The risk of pancreatic allograft failure was not significantly increased.
We conclude that HCV infection in kidney-pancreas transplant patients results in a significantly increased risk of kidney allograft failure and death.
尽管大多数研究未显示丙型肝炎病毒（HCV）感染的单纯肾移植受者的患者或移植物存活率降低，但HCV感染对HCV感染的肾胰联合移植受者的患者和移植物存活率的影响尚未得到研究。
我们对1989年1月至1996年5月期间接受移植的137例肾胰联合移植受者进行了回顾性队列分析。通过聚合酶链反应阳性确定HCV感染。使用具有时间依赖性协变量的Cox比例风险模型计算死亡和移植物失败的相对风险。调整相对风险（aRR）以控制移植时接受OKT3治疗的排斥反应次数和受者的巨细胞病毒状态。
HCV感染患者的平均随访时间为30.4个月，未感染患者为31.7个月。7例（5.1%）患者在移植前感染HCV，1例（1%）在移植后复发，4例（2.9%）在移植后获得感染。与HCV阴性组相比，HCV感染组移植后死亡风险增加3.7倍（95%置信区间[CI]，1.0-13.5），aRR为5.5（95%CI，1.5-20.0）。HCV感染组（n=3）的死亡通常是肝功能衰竭和败血症的结果，而未感染组（n=11）的死亡主要是心血管原因。HCV感染患者发生肾移植失败的可能性比HCV阴性患者高3.4倍（95%CI，1.1-10.1），aRR为5.1（95%CI，1.7-15.4）。胰腺移植失败的风险没有显著增加。
我们得出结论，肾胰联合移植患者中的HCV感染导致肾移植失败和死亡的风险显著增加。
