The impact of hepatitis C virus infection on renal allograft recipients.
The impact of hepatitis C virus infection on renal allograft recipients.
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丙型肝炎病毒感染对同种异体肾移植受者的影响。
DOI：
10.1038/ki.1994.29
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发表时间：
1994
影响因子：
19.6
通讯作者：
Miller,J
中科院分区：
文献类型：
--
作者：
Roth,D;Zucker,K;Cirocco,R;DeMattos,A;Burke,GW;Nery,J;Esquenazi,V;Babischkin,S;Miller,J
丙型肝炎病毒感染对肾移植受者的影响。采用第二代丙型肝炎病毒重组免疫印迹法（RIBA）筛选641例同种异体肾移植受者的围手术期血清。移植时抗hcv阳性109例（17%）。在logistic回归模型中发现RIBA阳性是移植后肝病的独立预测因子（P < 0.05）。此外，RIBA阳性患者发生感染事件（P = 0.03）和排斥事件（P = 0.002）的风险更高。在剂量反应关系中，抗淋巴细胞球蛋白诱导治疗的累积剂量是移植后肝脏疾病的独立预测因子。定性PCR显示74%围手术期RIBA阳性患者在当前血清样本中可检测到HCV RNA。此外，采用竞争性模板PCR和限制性片段长度多态性鉴定HCV菌株的HCV RNA定量分析表明，血清和三种不同的HCV菌株（BK， Hutch和HCV-1）的HCV RNA拷贝数/ml范围很大。移植后HCV RNA的数量和菌株类型与转氨酶异常无关。到目前为止，还没有发现抗hcv状态对精算患者和移植物存活的影响。这项研究表明抗hcv不是肾移植的禁忌症；然而，我们建议对抗- hcv阳性患者的移植前评估包括肝活检，以正确分期疾病。鉴于感染和排斥的风险增加，需要密切的移植后随访。
The impact of hepatitis C virus infection on renal allograft recipients. A second generation hepatitis C virus recombinant immunoblot assay (RIBA) was used to screen stored perioperative serum from 641 renal allograft recipients. One hundred and nine (17%) were anti-HCV positive at the time of transplant. RIBA positivity was found to be an independent predictor of post-transplant liver disease in a logistic regression model (P < 0.05). Moreover, RIBA positive patients were at greater risk for infectious events (P = 0.03) and rejection episodes (P = 0.002). The cumulative dose of antilymphoblast globulin administered as induction therapy was an independent predictor of post-transplant liver disease in a dose response relationship. Qualitative PCR showed that 74% of the perioperative RIBA positive patients had detectable HCV RNA in a current serum sample. Further, quantitative HCV RNA analysis with a competitive template PCR and HCV strain identification by restriction fragment length polymorphism demonstrated a large range of HCV RNA copies/ml of serum and three different HCV strains (BK, Hutch and HCV-1). Neither quantity of HCV RNA nor strain type correlated with abnormal transaminases post-transplant. As yet, there has not been an effect of anti-HCV status on actuarial patient and graft survival. This study suggests that anti-HCV is not a contraindication to renal transplantation; however, we would recommend that the pre-transplant evaluation of the anti-HCV positive patient include a liver biopsy to properly stage the disease. Close post-transplant follow-up is required in view of the increased risk for infection and rejection.