Long-Term Impact of Hepatitis B, C Virus Infection on Renal Transplantation
Long-Term Impact of Hepatitis B, C Virus Infection on Renal Transplantation
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DOI：
10.1159/000046265
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发表时间：
2001-07
影响因子：
4.2
通讯作者：
Wen-Chin Lee;K. Shu;Chi-hung Cheng;Ming-Ju Wu;Cheng-Hsu Chen;J. Lian
中科院分区：
文献类型：
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作者：
Wen-Chin Lee;K. Shu;Chi-hung Cheng;Ming-Ju Wu;Cheng-Hsu Chen;J. Lian
慢性肝病及其并发症是肾移植受者的主要问题。目的探讨B、C型肝炎病毒感染对肾移植术后远期预后的影响。1984年1月至1999年12月间在我院接受肾移植并接受随访的477例患者入选。HBsAg检测采用放射免疫法，抗-HCV抗体检测采用第二代放射免疫试剂盒。每3个月检查一次SGOT/ SGPT。动态CT扫描诊断肝癌，血管造影显示甲胎蛋白升高，血管丰富，病理证实。HBV感染率为9.9%（n = 47），HCV感染率为28.5%（n = 136），HBV/HCV共感染率为3.1%（n = 15）。HBV-/HCV-、HBV-/HCV+、HBV+/HCV-、HBV +/HCV+组肝癌发生率分别为1.4%（n = 4）、4.4%（n = 6）、6.4%（n = 3）、6.7%（n = 1）（p = 0.114）。肝硬化/肝功能衰竭的发生率分别为3.2%（n = 9）、6.6%（n = 9）、21.3%（n = 10）、20%（n = 3）（p < 0.001）。慢性肝病发生率分别为10.4%（n = 29）、45.6%（n = 62）、66%（n = 31）、80%（n = 12）（P < 0.001）。HBV感染组的患者和移植物存活率低于其他组。考克斯回归分析显示，HBV感染可能是患者死亡的独立危险因素，尽管统计学意义仅为临界值。根据该分析模型，HBV和HCV感染的患者没有移植物丢失的风险。HBV感染者肝癌、肝功能衰竭、移植物衰竭和死亡的发生率较高。因此，HBV感染的患者谁是肾移植的候选人应仔细评估。HCV感染对肾移植受者的预后影响不大。需要更长时间的随访来阐明丙型肝炎病毒对肾移植受者的影响。
Chronic liver disease and its complications are major problems in renal transplant recipients. Our aim was to elucidate the influence of hepatitis B, C virus infection on the long-term outcome of renal transplantation. Four hundred and seventy-seven patients who received renal transplantation between January 1984 and December 1999, and who were followed up at our hospital were enrolled. HBsAg was detected by the RIA method and anti-HCV Ab was assayed by the second-generation RIA kit. SGOT/ SGPT were checked every 3 months. Hepatoma was diagnosed by dynamic CT scan, elevated α-fetoprotein, hypervascularity by angiography and confirmed by pathological examination. The prevalence of HBV, HCV, coinfected HBV/HCV was 9.9% (n = 47), 28.5% ( n = 136), 3.1% (n = 15), respectively. The incidences of hepatoma in the HBV–/HCV–, HBV–/HCV+, HBV+/HCV–, HBV+/HCV+ groups were 1.4% (n = 4), 4.4% (n = 6), 6.4% (n = 3), 6.7% (n = 1), respectively (p = 0.114). The incidences of liver cirrhosis/hepatic failure were 3.2% (n = 9) , 6.6% (n = 9) , 21.3% (n = 10) , 20% (n = 3), respectively (p < 0.001). The frequencies of chronic liver disease were 10.4% (n = 29) , 45.6% (n = 62) , 66% (n = 31) , 80% (n = 12), respectively (p < 0.001). Patient and graft survival rates were lower in the HBV-infected group than in the other groups. Cox regression analysis revealed that HBV infection is likely an independent risk factor for patient mortality although the statistical significance was only borderline. Patients with HBV as well as HCV infection were not at risk of graft loss according to this model of analysis. Patients with HBV infection showed higher incidences of hepatoma, hepatic failure, graft failure and death. Therefore, HBV-infected patients who are candidates for renal transplantation should be carefully evaluated. It seems that HCV infection has little influence on the outcome of renal transplant recipients. A longer period of follow-up is needed to clarify the impact of HCV on renal transplant recipients.