European collaborative study on factors influencing outcome after liver transplantation for hepatitis C
European collaborative study on factors influencing outcome after liver transplantation for hepatitis C
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DOI：
10.1016/s0016-5085(99)70454-3
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发表时间：
1999-09-01
期刊：
影响因子：
29.4
通讯作者：
Samuel, D
中科院分区：
文献类型：
--
作者：
Féray, C;Caccamo, L;Samuel, D
背景与目的：丙型肝炎病毒（HCV）相关性肝病的肝移植的特点是移植物频繁感染HCV。确定了这种情况下发病率和死亡率的预后和危险因素。研究方法：对1984年至1995年在15个欧洲中心接受肝移植的652例连续抗-HCV阳性患者进行了回顾性研究; 102例合并感染B型肝炎病毒（HBV）的患者接受了免疫球蛋白预防性治疗，以获得抗B型肝炎表面抗原的抗体。结果：总体而言，5年生存率为72%。肝炎和肝硬化的五年精算率分别为80%和10%。在分析的268例患者中，分别有214例（80%）、24例（9%）和24例（9%）检测到基因型1b、1a和2。患者或移植物存活的唯一判别因素是肝细胞癌作为主要指征。复发性肝炎的独立危险因素包括移植前无HBV合并感染（相对风险[RR]，1.7; 95%置信区间[CI]，1.2-2.6; P = 0.005），基因型Ib（RR，2; 95% CI，1.3-2.9; P = 0.01），年龄> 49岁（RR，1.4; 95% CI，1.1-1.8; P = 0.01）。结论：尽管5年生存率令人满意，但HCV相关疾病的移植结果受到肝硬化显著风险的影响。基因型1b、年龄和移植前无HBV合并感染是HCV复发的危险因素。
Background & Aims: Liver transplantation for hepatitis C virus (HCV)-related liver disease is characterized by frequent graft infection by HCV. The prognosis and risk factors for morbidity and mortality in this condition were determined. Methods: A retrospective study of 652 consecutive anti-HCV-positive patients undergoing liver transplantation between 1984 and 1995 in 15 European centers was conducted; 102 patients coinfected with hepatitis B virus (HBV) received immunoglobulin prophylaxis for antibody to hepatitis B surface antigen. Results: Overall, 5-year survival was 72%. Five-year actuarial rates of hepatitis and cirrhosis were 80% and 10%. Genotypes 1b, 1a, and 2 were detected in 214 (80%), 24 (9%), and 24 (9%) of 268 patients analyzed. The only discriminant factor for patient or graft survival was hepatocellular carcinoma as primary indication. Independent risk factors for recurrent hepatitis included the absence of HBV coinfection before transplantation (relative risk [RR], 1.7; 95% confidence interval [CI], 1.2-2.6; P = 0.005), genotype Ib (RR, 2; 95% CI, 1.3-2.9; P = 0.01), and age > 49 years (RR, 1.4; 95% CI, 1.1-1.8; P = 0.01). Conclusions: The results of transplantation for HCV-related disease are compromised by a significant risk of cirrhosis, although 5-year survival is satisfactory. Genotype 1b, age, and absence of pretransplantation coinfection by HBV are risk factors for recurrent HCV.