Predictors of graft and patient survival in hepatitis C virus (HCV) recipients: Model to predict HCV cirrhosis after liver transplantation
Predictors of graft and patient survival in hepatitis C virus (HCV) recipients: Model to predict HCV cirrhosis after liver transplantation
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DOI：
10.1097/01.tp.0000267916.36343.ca
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发表时间：
2007-07-15
期刊：
影响因子：
6.2
通讯作者：
Beckebaum, Susanne
中科院分区：
文献类型：
--
作者：
Iacob, Speranta;Cicinnati, Vito R.;Beckebaum, Susanne
背景丙型肝炎病毒（HCV）在肝移植（LT）后复发几乎是普遍的，但移植物中HCV复发的自然史是高度可变的。我们的研究有两个目的：1）评估不同的LT前和LT后因素对HCV移植受者的移植物和患者存活率的影响; 2）建立一个模型，预测LT后5年HCV相关移植物肝硬化的风险。本研究共考虑了168例LT。采用单因素和多因素考克斯比例风险回归模型，以及Logistic回归分析，建立预测肝移植后5年内HCV肝硬化的模型。移植物和患者生存率降低的预测因素包括近期移植的患者（2000 - 2004），诱导期未使用硫唑嘌呤，短期使用吗替麦考酚酯和泼尼松治疗（50岁被确定为5年内移植物肝硬化的独立预测因素。建立一个预测模型，以计算6个月时移植物HCV肝硬化的风险评分在5年内LT后使用的公式，其中包括确定的独立预测因子。受试者工作特征曲线下面积为0.83，提示对中期HCV移植物再感染有较好的预测能力。这个模型可能是一个有用的工具，更好地确定高危HCV患者应选择早期开始抗病毒治疗。
Background. Hepatitis C virus (HCV) recurrence after liver transplantation (LT) is almost universal, but the natural history of recurrent HCV in the allograft is highly variable. Our study had two aims: 1) to assess the impact of different pre- and postLT factors on graft and patient survival in HCV transplant recipients and 2) to create a model which may predict the patients at risk for HCV-related graft cirrhosis at 5 years postLT.Methods. A total of 168 LTs were considered for this study. Univariate and multivariate Cox proportional hazards regression model was used, as well as logistic regression analysis to create a model of prediction of HCV cirrhosis within 5 years after LT.Results. Predictive factors for both decreased graft and patient survival included patients recently transplanted (20002004), induction without azathioprine, short-term therapy with mycophenolate mofetil and prednisone (50 years were identified as independent predictors of graft cirrhosis within 5 years. A predictive model was established in order to calculate at 6 months a risk score for graft HCV cirrhosis within 5 years postLT using a formula that included the identified independent predictors. The area under receiver operating characteristic curve was 0.83, indicating a good ability to predict medium-term HCV allograft cirrhosis.Conclusion. This model may be a useful tool for better identifying high-risk HCV patients who should be selected for early initiation of antiviral therapy.