Hepatitis C virus and liver transplantation.
Hepatitis C virus and liver transplantation.
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DOI：
10.1016/s1089-3261(05)70210-5
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发表时间：
2001-11-01
影响因子：
5.1
通讯作者：
Keeffe, E B
中科院分区：
文献类型：
--
作者：
Ahmed, A;Keeffe, E B
免疫抑制治疗、手术技术和围手术期管理的进步使慢性病毒性肝炎肝移植后患者的长期生存率接近90%。肝移植转诊数量的增加反映了慢性HCV感染作为终末期肝病原因的影响。与B型肝炎不同，目前仍没有有效的治疗方法来预防肝移植后丙型肝炎的复发。与普遍HCV感染复发相关的同种异体移植物损伤的范围从没有组织学损伤的证据到轻度炎症，再到小部分患者的严重疾病和同种异体移植物失败。各种因素可以解释这些不同的结果，包括移植前病毒血症的程度，HLA相容性，存在更多的致病性HCV基因型，细胞免疫反应的完整性，和免疫抑制的类型。幸运的是，患者的生存期似乎不会受到短期影响;慢性丙型肝炎肝移植的长期结局尚不清楚，但可能会降低。干扰素加利巴韦林的联合治疗似乎是移植后复发性丙型肝炎的一种有前途的治疗策略，聚乙二醇干扰素加利巴韦林的使用可能会改善这些结果。中度至重度移植物肝炎患者适合联合抗病毒治疗。肝移植受者中组织学证实的复发性丙型肝炎与生活质量受损、身体状况较差以及抑郁症的发生率高于无HCV感染和无HCV复发的患者相关。总之，抗HCV感染的抗病毒治疗的持续改善可能最终减少需要肝移植的患者数量。慢性HCV感染的合适候选者因此需要用聚乙二醇干扰素加利巴韦林联合治疗，以期减少疾病进展。最近的研究，需要确认，表明对标准抗病毒治疗无应答者可能受益于维持治疗。慢性丙型肝炎和失代偿性肝硬化患者的供体库可以通过使用HCV阳性供体和增加使用更新的外科技术来改善，包括成人间活体肝移植和劈离式肝移植。
Advances in immunosuppressive therapy, operative techniques, and perioperative management have resulted in long-term patient survival rates approaching 90% following liver transplantation for chronic viral hepatitis. The increasing number of referrals for liver transplantation reflects the impact of chronic HCV infection as a cause of end-stage liver disease. Unlike hepatitis B, there is still no effective treatment in preventing recurrent hepatitis C after liver transplantation. The spectrum of allograft injury related to universal HCV infection recurrence ranges from no evidence of histologic injury to mild inflammation to severe disease with allograft failure in small proportion of patients. Various factors may explain these differing outcomes, including degree of pretransplantation viremia, HLA compatibility, presence of more pathogenic HCV genotypes, integrity of cellular immune response, and type of immunosuppression. Fortunately, patient survival does not seem to be affected short-term; the long-term outcome of liver transplantation for chronic hepatitis C is unclear but is likely to be decreased. Combination therapy with interferon plus ribavirin seems to be a promising treatment strategy for posttransplantation recurrent hepatitis C, and the use of pegylated interferon plus ribavirin may improve these results. Patients with moderate to severe allograft hepatitis are appropriate candidates for combination antiviral therapy. Histopathologically documented recurrent hepatitis C in liver transplant recipients is associated with impaired quality of life, inferior physical condition, and a higher incidence of depression compared with patients who did not have HCV and in those without HCV recurrence. In conclusion, it is possible that the continued improvements in antiviral therapy against HCV infection may ultimately decrease the number of patients needing liver transplantation. Suitable candidates with chronic HCV infection thus warrant treatment with pegylated interferon plus ribavirin combination therapy in the hope of decreasing disease progression. Recent studies, which require confirmation, suggest that nonresponders to standard antiviral therapy may benefit from maintenance therapy. The donor pool for patients with chronic hepatitis C and decompensated cirrhosis can be improved by using HCV-positive donors and by increasing utilization of newer surgical techniques, including adult-to-adult living-donor liver transplantation and split-liver transplantation.