Impact of immunosuppression and acute rejection on recurrence of hepatitis C: results of the National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database.
Impact of immunosuppression and acute rejection on recurrence of hepatitis C: results of the National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database.
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免疫抑制和急性排斥反应对丙型肝炎复发的影响：国家糖尿病、消化和肾脏疾病研究所肝移植数据库的结果。
DOI：
10.1053/jtls005s00107
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发表时间：
1999
期刊：
影响因子：
--
通讯作者：
Seaberg,E
中科院分区：
文献类型：
--
作者：
Charlton,M;Seaberg,E
尽管早期（术后前6周）急性细胞排斥反应对肝移植受者的生存率的影响总体上是有利的，但我们假设急性细胞排斥反应的治疗对丙型肝炎病毒（HCV）感染和HCV阴性移植受者的患者和移植物生存率可能有不同的影响。我们研究了免疫抑制和排斥反应对166例HCV感染者和602例HCV阴性移植受者的患者和移植物存活率的影响，这些受者登记在国家糖尿病、消化和肾脏疾病研究所肝移植数据库中。所有数据均前瞻性收集。早期急性细胞排斥反应与死亡率的相关性采用具有时间依赖性协变量的考克斯比例风险模型确定。HCV感染者的中位随访时间为5.0年，HCV阴性移植受者的中位随访时间为5.2年。HCV感染的移植受者发生急性细胞性和激素抵抗性排斥反应的频率与接受肝移植治疗大多数其他适应症的患者相似。死亡风险显著增加（相对危险度= 2.4; P=. 03)与HCV阴性移植受者相比，HCV感染的移植受者发生早期急性细胞排斥反应。没有HCV感染的移植受者发生继发于慢性排斥反应的同种异体移植失败。钙调磷酸酶抑制剂的选择并不影响移植后的结果。早期急性细胞排斥反应在HCV感染和HCV阴性移植受者中发生的频率相似。虽然早期急性细胞排斥反应的发作与HCV阴性移植受者的累积死亡率较低相关，但对于HCV感染的移植受者来说，情况正好相反，他们在早期急性细胞排斥反应发作后死亡率增加。在为HCV感染的移植受者制定初级免疫抑制和急性细胞排斥治疗方案时，应考虑早期急性细胞排斥对患者生存的不利影响。
Whereas the impact of early (first 6 postoperative weeks) acute cellular rejection on patient survival among liver transplant recipients as a whole has been reported to be favorable, we hypothesized treatment for acute cellular rejection may have differing impacts on patient and graft survival in hepatitis C virus (HCV)-infected and HCV-negative transplant recipients. We studied the impact of immunosuppression and rejection on patient and graft survival among the 166 HCV-infected and 602 HCV-negative transplant recipients enrolled onto the National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database. All data were collected prospectively. The association of early acute cellular rejection with mortality was determined using a Cox proportional hazards model with a time-dependent covariate. Median follow-up was 5.0 years for HCV-infected and 5.2 years for HCV-negative transplant recipients. HCV-infected transplant recipients experienced similar frequencies of acute cellular and steroid-resistant rejection as patients undergoing liver transplantation for most other indications. The mortality risk was significantly increased (relative risk= 2.4; P=. 03) for HCV-infected transplant recipients who developed early acute cellular rejection compared with HCV-negative transplant recipients. None of the HCV-infected transplant recipients developed allograft failure secondary to chronic rejection. The choice of calcineurin inhibitor did not affect posttransplantation outcomes. Early acute cellular rejection occurs at similar frequencies in HCV-infected and HCV-negative transplant recipients. Although an episode of early acute cellular rejection is associated with a lower cumulative mortality among HCV-negative transplant recipients, the opposite is true for HCV-infected transplant recipients, who experience an increased risk for mortality after an episode of early acute cellular rejection. The adverse impact of early acute cellular rejection on patient survival should be considered in developing primary immunosuppression and acute cellular rejection treatment protocols for HCV-infected transplant recipients.