Long-Term Follow-Up and Outcome of Liver Transplantation From Anti-Hepatitis C Virus-Positive Donors: A European Multicentric Case-Control Study
Long-Term Follow-Up and Outcome of Liver Transplantation From Anti-Hepatitis C Virus-Positive Donors: A European Multicentric Case-Control Study
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DOI：
10.1097/tp.0b013e318219eb8f
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发表时间：
2011-06-15
期刊：
影响因子：
6.2
通讯作者：
Gerunda, Giorgio Enrico
中科院分区：
文献类型：
--
作者：
Ballarin, Roberto;Cucchetti, Alessandro;Gerunda, Giorgio Enrico
背景资料。丙型肝炎病毒(丙型肝炎病毒)感染在普通人群中日益流行，导致携带该病毒的潜在器官捐赠者的频率增加。鉴于器官移植供需之间的巨大差异，考虑抗-丙型肝炎病毒阳性供者的肝脏是否适合移植变得至关重要。根据欧洲多中心数据库，694名丙型肝炎病毒相关性肝硬变患者接受了肝移植，其中11%接受了抗丙型肝炎病毒阳性捐赠者的肝移植。在这组患者中，我们选择了63名患者(研究组)，经过1：1的病例对照方法，将他们与接受抗丙型肝炎病毒阴性供者移植的63名患者(对照组)进行了比较。只有肝组织纤维化评分不超过1分的预灌流肝活检结果用于移植。接受抗-HCV阳性移植的患者1年和5年的累积存活率分别为83.6%和61.7%，而对照组分别为95.1%和68.2%。在比较患者和移植物的总体存活率时，两组之间没有统计学差异(P=0.22和0.11)。在接受抗-HCV阳性移植的患者中，丙型肝炎的复发倾向于更快，尽管没有达到统计学意义(P=0.07)。我们不建议不加区别地使用抗-丙型肝炎病毒阳性的供者，特别是如果丙型肝炎病毒RNA阳性，因为使用这种移植物可能与晚期纤维化有关，这是我们观察到的早期丙型肝炎复发的主要危险因素。
Background. The growing prevalence of hepatitis C virus (HCV) infection in the general population has resulted in an increased frequency of potential organ donors that carry the virus. Given the significant disparity between organ supply and demand for transplantation, it becomes essential to consider whether livers from anti-HCV-positive donors may be considered suitable for transplantation.Methods. Based on a multicenter European database, 694 patients with HCV-related cirrhosis underwent liver transplantation and 11% of them received the graft from anti-HCV-positive donors. Of this group, we selected 63 patients (study group) and, after a 1:1 case-control approach, compared them with 63 patients that received an anti-HCV-negative donor graft (control group). Only grafts with preperfusion liver biopsy results with a fibrosis score of not more than 1 were used for transplantation.Results. Patients who received anti-HCV-positive grafts had a cumulative survival rate of 83.6% and 61.7% at 1 and 5 years, respectively, vs. 95.1% and 68.2% for the control group. In comparing overall patient and graft survival, there was no statistically significant difference between the two groups (P = 0.22 and 0.11). Recurrence of hepatitis C tended to be more rapid in the group of patients who received anti-HCV-positive grafts, although it did not reach statistical significance (P = 0.07).Conclusions. We do not recommend the indiscriminate use of anti-HCV-positive donors, especially if HCV-RNA positive, as the use of this kind of graft could be linked to an advanced stage of fibrosis, the main risk factor we observed for earlier hepatitis C recurrence.