Retrospective study on the impact of hepatitis C virus infection on kidney transplant patients over 20 years.
Retrospective study on the impact of hepatitis C virus infection on kidney transplant patients over 20 years.
复制标题
20多年来丙型肝炎病毒感染对肾移植患者影响的回顾性研究
作者：
T. Hanafusa;Yasuji Ichikawa;H. Kishikawa;M. Kyo;T. Fukunishi;Y. Kokado;Akihiko Okuyama;Yoshitake Shinji;Shunsuke Nagano
背景
大多数慢性肝炎可归因于丙型肝炎病毒(丙型肝炎病毒)感染，而对肾移植受者的临床影响尚不清楚。本研究旨在评估丙型肝炎病毒感染对肾移植受者的长期影响，并探讨干扰素-α治疗慢性活动性丙型肝炎的疗效和风险。
方法
对1973~1996年间280例肾移植患者的乙肝表面抗原(HBs)和丙型肝炎病毒抗体(HCVAb)进行了前瞻性和回顾性的检测。分析两组患者存活率、移植物存活率、肝功能障碍发生率及死亡原因。对10例慢性活动性丙型肝炎患者进行干扰素-α治疗。
结果
肝炎病毒感染率为34.3%(96/280)，其中乙肝表面抗原携带者为3.2%(9/280)，丙型肝炎病毒抗体携带者为28.6%(80/280)，两者同时携带者为2.5%(7/280)。另184例(65.7%)HBs Ag和HCVAb均为阴性。HCVAb携带者发生肝功能障碍的发生率为55%，显著高于未感染组的9.2%(P<；0.01)。与未感染组相比，HCVAb携带者在第二个十年的存活率较低：10年存活率为83.7%比88.91%(P=0.44)，20年存活率为63.9%比87.9%(P<；0.05)。存活率低是肝病死亡的结果。感染组中有5例患者死于此类疾病，而同期未感染组无一例死亡(P<；0.01)。经干扰素-α治疗后，8例患者的生化活动恢复正常或改善，而仅3例患者的丙型肝炎病毒RNA滴度下降。仅1例患者在治疗后2年内维持正常的生化标志物和检测不到的丙型肝炎病毒核糖核酸水平。有5名患者因急性排斥反应、糖尿病恶化和抑郁等不良反应而停止治疗。
结论
从长远来看，丙型肝炎病毒感染对肾移植受者有重大影响，特别是在第二个十年。我们的初步研究显示，干扰素-α治疗对感染丙型肝炎病毒的受者只有部分疗效，但有很高的急性排斥反应风险。
BACKGROUND
The majority of chronic hepatitis is ascribable to hepatitis C virus (HCV) infection, whereas the clinical impact has not been understood in kidney transplant recipients. Our current study was carried out to assess the impact of HCV infection on kidney recipients over the long-term, and to investigate the effect and risk of interferon-alpha (IFN-alpha) therapy for chronic active hepatitis C.
METHODS
Hepatitis B surface antigen (HBsAg) and antibody to HCV (HCVAb) were examined prospectively and retrospectively in 280 patients, who underwent kidney transplants in the period from 1973 to 1996. The patient survival rate, the graft survival rate, the incidence of liver dysfunction and the cause of mortality among the HCV infected and noninfected groups were analyzed. IFN-alpha therapy was performed on 10 patients with chronic active hepatitis C.
RESULTS
Prevalence of the hepatitis virus was quite high at 34.3% (96/280): the frequency of the HBsAg carrier was 3.2% (9/280), that of the HCVAb carrier was 28.6% (80/280) and that of the both carriers was 2.5% (7/280). The other 184 cases (65.7%) were negative for both HBsAg and HCVAb. Liver dysfunction developed at the significantly higher incidence of 55% in HCVAb carriers compared to the 9.2% of the noninfected group (P<0.01). HCVAb carriers had a poor survival rate in the second decade compared to the noninfected group: 83.7% vs. 88.91% for 10-year survival (P=0.44) and 63.9% vs. 87.9% for 20-year survival (P<0.05). The poor survival rate was a result of the mortality from liver disorder. Five patients died of such disease in the infected groups whereas no noninfected patient died in the same period (p<0.01). As the result of IFN-alpha therapy, biochemical activity normalized or improved in eight cases, whereas the HCV-RNA titer was reduced only in three patients. Only one patient maintained normal biochemical markers and undetectable levels of HCV-RNA for 2 years after treatment. The therapy was discontinued for five patients with the adverse effects of acute rejection, deterioration of diabetes, and depression.
CONCLUSIONS
HCV infection has a significant impact on kidney transplant recipients over the long term and in particular affects them in the second decade. Our pilot study revealed only partial efficacy of IFN-alpha therapy for HCV-infected recipients, but with the high risk of acute rejection.
影响因子：
6.2
作者：
Roth,D;Fernandez,JA;Burke,GW;Esquenazi,V;Miller,J
通讯作者：
Miller,J