Kidney Transplantation in the Patient with Hepatitis C Virus Infection
Kidney Transplantation in the Patient with Hepatitis C Virus Infection
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DOI：
10.1159/000332385
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发表时间：
2012-01-01
期刊：
影响因子：
--
通讯作者：
Roth, David
中科院分区：
文献类型：
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作者：
Morales, Jose M.;Bloom, Roy;Roth, David
肝脏疾病是肾移植后的重要合并症，丙型肝炎病毒（HCV）感染已被证明是导致这一并发症的主要原因。抗hcv阳性肾移植受者在移植后发生蛋白尿、慢性排斥反应、感染、肾小球肾炎和新发糖尿病（NODAT）的风险更高。与一些患者的进展性肝病一起，这些并发症都导致抗hcv阳性患者与未感染的患者相比，患者和移植物存活率较低。抗丙型肝炎病毒阳性人群死亡率的增加主要是由于心血管疾病、肝脏疾病和感染的发病率较高。丙型肝炎病毒也可导致某些肝外肿瘤的发生，如移植后淋巴细胞增生性疾病。HCV感染也是移植物损失的独立危险因素，可能与NODAT、慢性排斥/移植肾小球病和HCV相关肾小球肾炎的发展有关。尽管HCV感染患者肾移植相关的合并症增加，移植为HCV感染的终末期肾病患者提供了最好的长期结果。最后，在移植后的环境中，应该考虑一些旨在尽量减少HCV感染潜在不良后果的干预措施。调整免疫抑制，在门诊认真随访，早期发现蛋白尿、肾功能不全、感染、NODAT、肿瘤或肝病恶化，是HCV感染患者移植后护理的重要组成部分。巴塞尔S. Karger股份有限公司版权所有
Liver disease is an important comorbidity following kidney transplantation, and hepatitis C virus (HCV) infection has been demonstrated to be the leading cause of this complication. Anti-HCV-positive kidney transplant recipients have a higher risk for developing proteinuria, chronic rejection, infections, glomerulonephritis and new-onset diabetes after transplantation (NODAT). Together with progressive liver disease in some patients, these complications all contribute to inferior patient and graft survival rates observed in anti-HCV-positive patients when compared to their uninfected counterparts. The increased mortality in the anti-HCV-positive cohort is largely as a result of a higher incidence of cardiovascular disease, liver disease and infections. HCV can also contribute to the development of some extrahepatic neoplasias, such as posttransplant lymphoproliferative disease. HCV infection is also an independent risk factor for graft loss, likely contributed to by the development of NODAT, chronic rejection/transplant glomerulopathy and HCV-related glomerulonephritis. Despite the increased comorbidities associated with kidney transplant in the HCV-infected patient, transplantation offers the best long-term outcomes for the end-stage renal disease patient with HCV infection. Finally, several interventions designed to minimize the potentially adverse consequences of HCV infection should be considered in the posttransplant setting. Adjustment of immunosuppression and careful follow-up in the outpatient clinic for early detection of proteinuria, renal insufficiency, infection, NODAT, neoplasia or worsening of liver disease are important components of the posttransplant care of the patient with HCV infection. Copyright (C) 2012 S. Karger AG, Basel