Incidence of hepatitis C in patients receiving different preparations of hepatitis B immunoglobulins after liver transplantation
Incidence of hepatitis C in patients receiving different preparations of hepatitis B immunoglobulins after liver transplantation
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DOI：
10.7326/0003-4819-128-10-199805150-00003
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发表时间：
1998-05-15
影响因子：
39.2
通讯作者：
Bismuth, H
中科院分区：
文献类型：
--
作者：
Féray, C;Gigou, M;Bismuth, H
背景：肝移植术后B型肝炎病毒（HBV）或丙型肝炎病毒（HCV）感染的复发是一个临床问题。针对B型肝炎表面抗原（HBIG）的多克隆免疫球蛋白可预防HBV感染的复发，但对HCV感染尚无有效的预防措施。在法国对献血者进行筛查之前，HBIG可能含有HCV抗体目的：确定1990年前后肝移植术后HBIG对丙型肝炎发生率的影响。设计：回顾性队列研究。地点：一所大学医院的肝移植科。患者：1984 ~ 1994年连续428例因肝硬化行肝移植的患者。测量：移植前和移植后1年血清HCVRNA检测及移植肝活检结果。在218例移植前有HCV感染的患者中，接受HBIG的患者移植后HCV病毒血症的发生率低于未接受HBIG的患者（46例患者中有25例[54%]，172例患者中有162例[94%]; P < 0.001）。在接受HBIG治疗的患者中，1990年3月之前接受移植的患者移植后HCV病毒血症的发生率低于1990年3月之后接受移植的患者（33例患者中15例[45%]与13例患者中10例[77%]; P = 0.05）。在210例移植前无HCV感染的患者中，接受HBIG的患者获得性感染的发生率明显低于未接受HBIG的患者（68例患者中有18例[26%]，86例患者中有40例[47%]; P < 0.001）。1990年3月之前，在接受HBIG治疗的患者中可一过性检测到被动传播的抗-HCV。多因素分析表明，在移植前HCV感染的患者中，没有HBIG和1990年3月以后的移植是独立的显着的危险因素慢性丙型肝炎transplantation.Conclusions：多克隆免疫球蛋白治疗病毒去污和含有抗-HCV可以预防HCV感染。
Background: Recurrence of hepatitis B virus (HBV) or hepatitis C virus (HCV) infection after liver transplantation is a clinical problem. Polyclonal immunoglobulins against hepatitis B surface antigen (HBIGs) prevent the recurrence of HBV infection, but no effective prophylaxis is available for HCV infection. Before screening of blood donors was introduced in France, HBIGs may have contained antibody to HCV (anti-HCV).Objective: io determine the influence of HBIG on the occurrence of hepatitis C after liver transplantation before and after 1990.Design: Retrospective cohort study.Setting: Liver transplantation unit of a university hospital.Patients: 428 consecutive patients who had liver transplantation because of cirrhosis between 1984 and 1994.Measurements: Detection of serum HCV RNA before and 1 year after transplantation and findings on liver graft biopsy.Results: Among the 218 patients who had HCV infection before transplantation, the incidence of HCV viremia after transplantation was lower in those receiving HBIG than in those not receiving HBIG (25 of 46 patients [54%] compared with 162 of 172 patients [94%]; P < 0.001). In patients receiving HBIG, the incidence of HCV viremia after transplantation was lower among those who had transplantation before March 1990 than among those who had transplantation after this date (15 of 33 patients [45%] compared with 10 of 13 patients [77%]; P = 0.05). Among the 210 patients without HCV infection before transplantation, acquired infection was significantly less frequent in those receiving HBIG than in those not receiving HBIG (18 of 68 patients [26%] compared with 40 of 86 patients [47%]; P < 0.001). Passively transmitted anti-HCV was transiently detected in patients receiving HBIG before March 1990. Multivariate analysis in patients with HCV infection before transplantation showed that the absence of HBIG and transplantation after March 1990 were independent significant risk factors for chronic hepatitis C after transplantation.Conclusions: Polyclonal immunoglobulins that are treated for viral decontamination and contain anti-HCV could prevent HCV infection.