Natural history of hepatitis B and C in renal allograft recipients
Natural history of hepatitis B and C in renal allograft recipients
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DOI：
10.1097/01.tp.0000161250.83392.73
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发表时间：
2005-05-15
期刊：
影响因子：
6.2
通讯作者：
Ponticelli, C
中科院分区：
文献类型：
--
作者：
Aroldi, A;Lampertico, P;Ponticelli, C
背景在肾移植受者中，大多数肝功能障碍病例是由B型肝炎病毒和丙型肝炎病毒（HCV）引起的。在1972年至1989年抗-HCV检测可用时，对286例肾移植受者的丙型肝炎和B肝炎的自然史进行了研究。所有患者术前均检测B型肝炎表面抗原（Ag），术后均检测抗-HCV（酶联免疫吸附法）。在1989年（移植后5.5 ± 4年）入组时，209例患者抗-HCV阳性（C+），42例患者HBsAg阳性（B+），35例患者同时为B+和C+（C+B+）。104例患者接受硫唑嘌呤（AZA）治疗，182例患者接受环孢素A（CsA）治疗。自移植以来，AZA治疗患者的中位随访时间为18年，CsA治疗患者为13年。肝活检显示慢性肝炎73例，肝硬化20例，纤维化淤胆型肝炎2例。在34例患者中，重复肝活检，并在24例患者中观察到纤维化进展。B+、C+和B+C+患者的12年患者生存率相似（分别为67%、78%和71%; P=无显著性）。肝脏相关死亡是B+和B+C+感染患者的第一死因（分别为58%和72%），而心血管疾病是C+患者的主要死因（40%）。多变量分析显示，年龄较大（> 40岁）（相对危险度[RR]，2.8）、B+状态（RR，2.36）和C+状态（RR，1.65）与患者生存率差独立相关。从长期来看，B+患者与肝病相关的死亡风险高于C+患者，合并感染不会使患者生存恶化。
Background. In renal allograft recipients, most cases of liver dysfunction are caused by hepatitis B virus and hepatitis C virus (HCV). The natural history of hepatitis C and B was studied in 286 renal allograft recipients who received a kidney allograft between 1972 and 1989 when tests for anti-HCV became available.Methods. In all patients, hepatitis B (HB) surface (s) antigen (Ag) was tested before and anti-HCV (by enzyme-linked immunosorbent assay 11) after transplantation.Results. At enrollment in 1989 (5.5 +/- 4 years after transplantation), 209 patients were anti-HCV positive (C+), 42 patients were HBsAg-positive (B+), and 35 patients were both B+ andC+ (C+B+). One hundred four patients were receiving azathioprine (AZA) and 182 were on cyclosporine A (CsA). Since transplantation, the median follow-up was 18 years in AZA-treated and 13 years in CsA-treated patients. Liver biopsy showed chronic hepatitis in 73 patients, cirrhosis in 20 patients, and fibrosing cholestatic hepatitis in 2 patients. In 34 patients, liver biopsy was repeated, and progression of fibrosis was observed in 24 patients. The 12-year patient survival rate was similar in B+, C+, and B+C+ patients (67%, 78%, and 71%, respectively; P=not significant). Liver-related death was the first cause of death in B+ and B+C+ infected patients (58% and 72%, respectively), whereas cardiovascular disease was the leading cause of death in C+ patients (40%). Multivariate analysis showed that older age (> 40 years) (relative risk [RR], 2.8), B+ status (RR, 2.36), and C+ status (RR, 1.65) were independently associated with a worse patient survival *Conclusions. In the long term, B+ patients had a higher risk of death related to liver disease than C+ patients, and co-infection did not worsen patient survival.