HEPATITIS C—ITS PREVALENCE IN END‐STAGE RENAL FAILURE PATIENTS AND CLINICAL COURSE AFTER KIDNEY TRANSPLANTATION
HEPATITIS C—ITS PREVALENCE IN END‐STAGE RENAL FAILURE PATIENTS AND CLINICAL COURSE AFTER KIDNEY TRANSPLANTATION
复制标题
丙型肝炎——终末期肾衰竭患者的患病率和肾移植后的临床病程
作者：
C. Stempel;J. Lake;G. Kuo;F. Vincenti
在接受透析的终末期肾衰竭患者中，慢性肝病的发病率很高。丙型肝炎病毒引起80%的输血后肝炎，高达80%的散发性肝炎和隐源性肝硬化。抗HCV抗体与活动性感染的存在高度相关。肾移植患者HCV感染的临床意义尚不清楚。第一部分：我们进行了一项描述性的横断面研究，所有肾衰竭患者承认肾移植之间的1/84和12/88。使用ELISA测定移植前血清中的抗HCV。将患者分为抗-HCV阳性（研究组）和抗-HCV阴性（对照组）。第二部分：从移植到现在，对两组进行了队列研究。比较采用t检验、Yates校正卡方分析、Mann Whitney非参数检验和多元回归分析。第一部分：在716份检测血清中，有76份存在抗-HCV。在性别、年龄、既往移植次数和基础肾脏疾病方面没有差异。四个变量预测抗-HCV的存在：输血次数;透析持续时间;静脉注射药物滥用和非白人种族。第二部分：对一组596例患者进行了进一步分析。两组的平均随访时间没有差异。移植物存活率、总死亡率或继发于肝病或败血症的死亡率无差异。基于这些结果，抗-HCV的存在不应该是肾移植的禁忌症。
There is a high incidence of chronic liver disease in end-stage renal failure patients on dialysis. Hepatitis C virus appears responsible for 80% of post-transfusion hepatitis, and up to 80% of sporadic hepatitis and cryptogenic cirrhosis. Anti-HCV antibodies correlate highly with the presence of active infection. The clinical implications of HCV infection in patients undergoing renal transplantation is unknown. Part I: We undertook a descriptive crosssectional study of all renal failure patients admitted for kidney transplant between 1/84 and 12/88. Pretransplant sera were assayed for anti-HCV using an ELISA. Patients were divided into anti-HCV-positive (study group) and anti-HCV-negative (controls). Part II: A cohort study was performed with both groups followed from the time of transplantation to the present. Comparisons were made by t tests, chi-square analysis with Yates correction, Mann Whitney test for nonparametric results and multiple regression analysis. Part I: Anti-HCV was present in 76 of 716 sera assayed. There were no differences in sex, age, number of previous transplants, and underlying renal disease. Four variables predicted the presence of anti-HCV: number of blood transfusions; duration on dialysis; i.v. drug abuse, and nonwhite race. Part II: A group of 596 patients was further analyzed. The mean duration of follow-up was not different between the two groups. There were no differences in graft survival, overall mortality, or mortality secondary to liver disease or sepsis. Based on these results, the presence of anti-HCV should not be a contraindication for kidney transplantation.