Progression of liver fibrosis in patients with chronic hepatitis C after orthotopic liver transplantation
Progression of liver fibrosis in patients with chronic hepatitis C after orthotopic liver transplantation
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DOI：
10.1097/01.tp.0000088668.28950.7c
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发表时间：
2003-11-27
期刊：
影响因子：
6.2
通讯作者：
Vargas, HE
中科院分区：
文献类型：
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作者：
Chopra, KB;Demetris, AJ;Vargas, HE
背景资料。丙型肝炎病毒相关性肝硬变是原位肝移植(OLTx)的主要适应症。肝移植后丙型肝炎复发很普遍，病程变化很大。本研究旨在寻找影响复发性丙型肝炎患者肝纤维化进展的因素。58例丙型肝炎患者在我们中心接受了OLTx，他们是根据可用的OLTx前血清或移植的肝脏样本选择的，并在OLTx至少6个月后获得肝活检。所有肝活检均在临床指征时进行，并使用改良的肝炎活动指数(HAI)进行评分。主要免疫抑制药物为他克莫司和泼尼松。该组包括41名男性(平均年龄49.6岁)。丙型肝炎病毒基因型分布为1a，31例(53%)，1b，16例(28%)，其他11例(19%)。平均随访时间为53.1个月。根据纤维化5期和6期的存在情况分析，1a型患者(n=31，平均46.3月)与其他基因型(n=27，平均60.1月；P=0.0088，对数等级检验)相比，无纤维化生存期显著降低。丙型肝炎病毒1a型的平均HAI评分显著高于1a型，尽管各型之间的存活率没有差异。同样，移植后感染巨细胞病毒的患者(n=4)比未感染巨细胞病毒的患者(n=54)有更高的纤维化进展率(平均无纤维化生存期29.0vs.53.0月，P=0.0004，对数等级检验)。人类白细胞抗原配型和急性排斥反应的发生率不影响纤维化的进展。对于丙型肝炎相关的慢性肝病，携带1a型丙型肝炎病毒的患者和在肝移植后发生巨细胞病毒感染的患者在肝移植后肝纤维化进展率较高。
Background. Hepatitis C virus (HCV)-related cirrhosis is the leading indication for orthotopic liver transplantation (OLTx). HCV recurrence is universal after OLTx, with a highly variable course. This study aimed to find factors that affect progression of fibrosis in recurrent HCV.Methods. Fifty-eight HCV patients underwent OLTx at our center who were selected on the basis of available preOLTx serum or explanted liver sample and liver biopsy obtained at least,6 months postOLTx. All liver biopsies were performed when clinically indicated and were scored using the modified Hepatitis Activity Index (HAI). Primary immunosuppression consisted of tacrolimus and prednisone.Results. The group included 41 males (mean age 49.6 years). HCV genotype distribution was 1a, 31 (53%); 1b, 16 (28%), and others 11 (19%). The mean follow-up was 53.1 months. Patients with genotype 1a (n=31; mean 46.3 months) had significantly lower fibrosis-free survival analyzed by the presence of fibrosis stages 5 and 6 when compared with other genotypes (n=27; mean 60.1 months; P=0.0088, log rank test). Mean HAI scores were significantly higher in HCV genotype la, although there were no differences in survival between genotypes. Similarly, patients with cytomegalovirus (CMV) infection postOLTx (n=4) had a higher fibrosis progression rate compared with those without CMV (n=54) (mean fibrosis-free survival 29.0 vs. 53.0 months P=0.0004, log-rank test). Human leukocyte antigen matching and rate of acute rejection did not influence progression of fibrosis.Conclusion. Patients with HCV genotype la and those developing CMV postOLTx have a higher rate of hepatic fibrosis progression after OLTx for HCV-related chronic liver disease.