Berenguer M, Prieto M, Córdoba J, Rayón J M, Carrasco D, Olaso V, San-Juan F, Gobernado M, Mir J, Berenguer J
Hepatogastroenterology Service, Hospital Universitario LA FE, Valencia, Spain.
J Hepatol. 1998 May;28(5):756-63. doi: 10.1016/s0168-8278(98)80224-9.
BACKGROUND/AIMS: We retrospectively studied 63 consecutive patients (mean age 54+/-8) with hepatitis C virus genotype 1b recurrence after liver transplantation and with a minimum histological follow-up of 1 year, in order to determine whether an early severe recurrence, defined as the development of chronic active hepatitis within the first 2 years post-liver transplantation, was associated with increased immunosuppression.
The 1st year immunosuppression data (rejection episodes, boluses of methyl-prednisolone, cumulative doses of prednisone and azathioprine, OKT3 use) were recorded, and evaluated as predictive of severe recurrence at 1 and 2 years post-liver transplantation. Chronic active hepatitis and rejection were defined by histological criteria. Immunosuppression consisted of cyclosporine, azathioprine and prednisone. The treatment of rejection was based on a "bolus" of 1 g methyl-prednisolone/3 days.
At 1 year, 64% (40/63) of the patients had chronic active hepatitis, whereas of the 40 patients who had a 2nd year biopsy available, 75% had chronic active hepatitis at 2 years. At 1 year post-liver transplantation, no significant association was observed between immunosuppression and the development of chronic active hepatitis. In contrast, at 2 years, rejection (p=0.006), treatment of rejection (p=0.05), methyl-prednisolone boluses (p=0.013) and the number of rejection episodes (p=0.0034) occurring during the 1st year post-liver transplantation were significantly more common in patients with chronic active hepatitis. There was also a trend towards higher cumulative steroids (9447+/-3176.5 vs 7891.5+/-2111 mg) and higher cumulative azathioprine doses (13472+/-11154 vs 6233.5+/-5937 mg) in patients with chronic active hepatitis as compared to those who did not develop chronic active hepatitis.
Rejection and/or its treatment may accelerate the natural history of hepatitis C virus genotype 1b infection post-liver transplantation.
背景/目的：我们回顾性研究了63例连续的肝移植后丙型肝炎病毒1b型复发患者（平均年龄54±8岁），这些患者的组织学随访时间至少为1年，以确定早期严重复发（定义为肝移植后前2年内发生慢性活动性肝炎）是否与免疫抑制增加有关。
记录第1年的免疫抑制数据（排斥反应发作、甲基泼尼松龙冲击量、泼尼松和硫唑嘌呤的累积剂量、OKT3的使用情况），并评估其对肝移植后1年和2年严重复发的预测价值。慢性活动性肝炎和排斥反应根据组织学标准定义。免疫抑制方案包括环孢素、硫唑嘌呤和泼尼松。排斥反应的治疗基于每3天1 g甲基泼尼松龙的“冲击”治疗。
1年时，64%（40/63）的患者患有慢性活动性肝炎，而在有第2年活检结果的40例患者中，75%在2年时患有慢性活动性肝炎。肝移植后1年，未观察到免疫抑制与慢性活动性肝炎的发生之间存在显著关联。相比之下，在2年时，肝移植后第1年发生的排斥反应（p = 0.006）、排斥反应的治疗（p = 0.05）、甲基泼尼松龙冲击量（p = 0.013）和排斥反应发作次数（p = 0.0034）在慢性活动性肝炎患者中明显更常见。与未发生慢性活动性肝炎的患者相比，慢性活动性肝炎患者的累积类固醇剂量也有升高趋势（9447±3176.5 vs 7891.5±2111 mg），硫唑嘌呤累积剂量也更高（13472±11154 vs 6233.5±5937 mg）。
排斥反应和/或其治疗可能会加速肝移植后丙型肝炎病毒1b型感染的自然病程。
