Mathurin P, Mouquet C, Poynard T, Sylla C, Benalia H, Fretz C, Thibault V, Cadranel J F, Bernard B, Opolon P, Coriat P, Bitker M O
Service d'Urologie, Hôpital Pitié-Salpêtrière, Paris, France.
Hepatology. 1999 Jan;29(1):257-63. doi: 10.1002/hep.510290123.
The impact of hepatitis B (HBV) and C (HCV) on patient survival after kidney transplantation is controversial. The aims of this study were (1) to assess the independent prognostic values of HBsAg and anti-HCV in a large renal transplant population, (2) to compare infected patients with noninfected patients matched for factors possibly associated with graft and patient survival, and (3) to assess the prognostic value of biopsy-proven cirrhosis. Eight hundred thirty-four transplanted patients were included: 128 with positive HBsAg (group I), 216 with positive anti-HCV (group II), and 490 without serological markers of HBV and HCV (group III). Fifteen percent and 29% of patients were HBsAg-positive and anti-HCV-positive, respectively. Ten-year survivals of group I (55 +/- 6%) and group II (65 +/- 5%) were significantly lower than survival of group III (80 +/- 3%, P <.001). At 10 years, among overall patients with HCV screening (n = 834), four variables had independent prognostic values in patient survival: age at transplantation (P <.0001), year of transplantation (P =.02), biopsy-proven cirrhosis (P =.03), and presence of HCV antibodies (P =.02). In the case control study, comparison of infected patients with their matched control patients showed that age at transplantation (P <.05), HBsAg (P =.005), and anti-HCV (P =.005) were independent prognostic factors. HCV, biopsy-proven cirrhosis, and age are independent prognostic factors of 10-year survival in patients with kidney grafts. The case-control study showed that anti-HCV and HBsAg were independently associated with patient and graft survivals. In infected patients, a routine liver histological analysis would improve selection of patients for renal transplantation.
乙肝（HBV）和丙肝（HCV）对肾移植患者生存率的影响存在争议。本研究的目的是：（1）在大量肾移植人群中评估HBsAg和抗-HCV的独立预后价值；（2）将感染患者与在可能与移植物及患者生存率相关因素上相匹配的未感染患者进行比较；（3）评估经活检证实的肝硬化的预后价值。纳入了834例移植患者：128例HBsAg阳性（I组），216例抗-HCV阳性（II组），490例无HBV和HCV血清学标志物（III组）。患者中HBsAg阳性和抗-HCV阳性的比例分别为15%和29%。I组（55±6%）和II组（65±5%）的10年生存率显著低于III组（80±3%，P<.001）。在10年时，在所有接受丙肝筛查的患者（n=834）中，有4个变量对患者生存率具有独立预后价值：移植时年龄（P<.0001）、移植年份（P=.02）、经活检证实的肝硬化（P=.03）以及丙肝抗体的存在（P=.02）。在病例对照研究中，将感染患者与其匹配的对照患者进行比较显示，移植时年龄（P<.05）、HBsAg（P=.005）和抗-HCV（P=.005）是独立的预后因素。丙肝、经活检证实的肝硬化和年龄是肾移植患者10年生存率的独立预后因素。病例对照研究表明，抗-HCV和HBsAg与患者及移植物生存率独立相关。对于感染患者，常规肝脏组织学分析将改善肾移植患者的选择。
