Durlik M, Gaciong Z, Soluch L, Rancewicz Z, Rowińska D, Kozłowska-Boszko B, Wyzga J, Walewska-Zielecka B, Rowiński W, Szmidt J, Lao M
Transplantation Institute, Warsaw Medical School.
Ann Transplant. 1996;1(2):11-2.
We evaluated the impact of concomitant infection with Hepatitis B virus (HBV) and Hepatitis C virus (HCV) on the clinical course after renal transplantation (Tx). In 335 patients (pts) transplanted between 1991 and 1993 we found 30 (9%) recipients who were positive for Hepatitis B surface antigen (HBsAg) (ELISA, Organon) and anti-HCV antibodies (immunoblot assay Lia Tek) preTx. Chronic liver disease (CLD) (two-fold or greater increase in serum ALT and AST levels for at least six months) developed in 40.7% coinfected pts as compared to 24.4% and 25.7% pts infected only with HCV or HBV, respectively. Maintenance immunosuppression consisted of P + Aza + CsA, mean follow-up time was 28 +/- 15 months. The mean time of the onset of CLD was 3.0 months (range: 1-18 months) after Tx. Percutaneous liver biopsy performed in 5 CLD pts revealed chronic active hepatitis (CAH) in 4 and chronic persistent hepatitis (CPH) in 1 pt. Four pts who had CAH and were positive for HCV RNA (RT PCR) in serum and for HBcAg in liver tissue, received interferon-alpha therapy for 6 months. Clinical improvement of liver function was observed in all of them, but none cleared HBsAg or HCV RNA. One pt lost his graft due to acute rejection. Concomitant infection with HBV and HCV is associated with the high risk of development of CLD early after Tx. We recommend that pretransplant evaluation of both anti-HCV and HBsAg positive pts should include liver biopsy to exclude potential recipients with CAH.
我们评估了乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）合并感染对肾移植（Tx）后临床病程的影响。在1991年至1993年间接受移植的335例患者中，我们发现30例（9%）受者在移植前乙型肝炎表面抗原（HBsAg）（酶联免疫吸附测定法，欧加农公司）和抗HCV抗体（免疫印迹法，Lia Tek）呈阳性。与仅感染HCV或HBV的患者分别为24.4%和25.7%相比，40.7%的合并感染患者发生了慢性肝病（CLD）（血清ALT和AST水平至少升高两倍且持续至少6个月）。维持免疫抑制方案为泼尼松+硫唑嘌呤+环孢素A，平均随访时间为28±15个月。CLD发病的平均时间为移植后3.0个月（范围：1 - 18个月）。对5例CLD患者进行的经皮肝活检显示，4例为慢性活动性肝炎（CAH），1例为慢性持续性肝炎（CPH）。4例CAH患者血清HCV RNA（逆转录聚合酶链反应）和肝组织中HBcAg呈阳性，接受了6个月的α干扰素治疗。所有患者肝功能均有临床改善，但均未清除HBsAg或HCV RNA。1例患者因急性排斥反应失去了移植肾。HBV和HCV合并感染与移植后早期发生CLD的高风险相关。我们建议，对于抗HCV和HBsAg均呈阳性的患者，移植前评估应包括肝活检，以排除潜在的CAH受者。
