Long-term follow-up of hepatitis C virus infection among organ transplant recipients: implications for policies on organ procurement.
Long-term follow-up of hepatitis C virus infection among organ transplant recipients: implications for policies on organ procurement.
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器官移植受者丙型肝炎病毒感染的长期随访：对器官获取政策的影响。
DOI：
10.1097/00007890-199703270-00010
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发表时间：
1997
期刊：
影响因子：
6.2
通讯作者：
Pereira,BJ
中科院分区：
文献类型：
--
作者：
Bouthot,BA;Murthy,BV;Schmid,CH;Levey,AS;Pereira,BJ
背景：丙型肝炎病毒（HCV）感染可引起缓慢进展的肝脏疾病.因此，移植后HCV感染的全面影响可能需要5-10年的follow-up.Methods.我们以前曾报道过HCV感染的影响，从供体获得（研究1）或获得移植前（研究2），对肝脏疾病的发病率，并对患者和移植物的存活率，中位随访时间为3-5年。在研究1中，我们比较了24名接受者的器官捐赠者谁是阳性的抗体对HCV（抗-HCV）的74名接受者的器官从抗-HCV阴性的捐助者。在研究2中，我们比较了23个抗-HCV阳性的受者和80个抗-HCV阴性的受者的肾脏，这些肾脏来自抗-HCV阴性的供体。在这份报告中，我们延长患者和移植物存活的中位随访期为6-7年，并讨论了我们的发现对器官采购政策的影响。结果：在研究2中，延长随访后，移植物丢失组间继续没有显着差异，但移植前抗HCV受体的死亡率仍显着较高。与移植前无抗-HCV的受者相比，移植前抗-HCV受者移植物丢失的相对危险度为1.30（0.66-2.58），死亡的相对危险度为2.60（1.15-5.90），脓毒症死亡的相对危险度为6.30（1.99 ~ 20）。在研究1中，经过长期随访，两组之间在移植物丢失或死亡方面仍然没有显著差异。与抗-HCV阴性供者相比，抗-HCV阳性供者器官移植失败的相对危险度为0.95（0.54-1.67），死亡相对危险度为1.00（0.49-2.02）.结论.本报告中提出的两项研究提供了一个明显的矛盾，关于移植时获得的HCV感染与移植前获得的HCV感染对移植后临床结局的影响。然而，在移植前获得HCV感染的受者中，而不是在移植时获得HCV的受者中，死亡率增加可以解释为前一组中HCV感染的持续时间较长。这些发现与已知的HCV感染的缓慢进展性质一致。然而，在没有明确证据表明对患者或移植物存活有不良影响的情况下，我们认为接受抗HCV阳性供体的肾脏的决定应由患者在与治疗医生讨论后做出。
Background.Hepatitis C virus (HCV) infection causes slowly progressive liver disease. Therefore, the full impact of HCV infection after transplantation may require 5-10 years of follow-up.Methods.We have previously reported the effect of HCV infection, acquired from the donor (study 1) or acquired before transplantation (study 2), on the incidence of liver disease, and on patient and graft survival with a median follow-up of 3-5 years. In study 1, we compared 24 recipients of organs from donors who were positive to antibody to HCV (anti-HCV) to 74 recipients of organs from anti-HCV-negative donors. In study 2, we compared 23 anti-HCV-positive recipients to 80 anti-HCV-negative recipients of kidneys from anti-HCV-negative donors. In this report, we extend the median follow-up period for patient and graft survival to 6-7 years, and discuss the implications of our finding on policies for organ procurement.Results.In study 2, after extended follow-up, there continued to be no significant difference between groups with respect to graft loss, but mortality remained significantly higher among recipients with anti-HCV before transplantation. Compared with recipients without anti-HCV before transplantation, the relative risk of graft loss among recipients with anti-HCV before transplantation was 1.30 (0.66-2.58), the relative risk of death was 2.60 (1.15-5.90), and the relative risk of death due to sepsis was 6.30 (1.99-20). In study 1, after extended follow-up, there continued to be no significant differences between groups, with respect to graft loss or death. Compared with recipients of organs from anti-HCV-negative donors, the relative risk of graft loss among recipients of organs from anti-HCV-positive donors was 0.95 (0.54-1.67), and the relative risk of death was 1.00 (0.49-2.02).Conclusions.The two studies presented in this report provide an apparent paradox, with respect to the impact of HCV infection acquired at the time of transplantation versus before transplantation on posttransplantation clinical outcomes. However, the increased mortality among recipients who acquired HCV infection before transplantation, but not among recipients who acquired HCV at the time of transplantation, could be explained by the longer duration of HCV infection in the former group. These findings are consistent with the known slowly progressive nature of HCV infection. However, in the absence of definitive evidence for an adverse effect on patient or graft survival, we believe that the decision to accept a kidney from an anti-HCV-positive donor should be made by the patient, after discussion with the treating physician.
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