Long-term outcome of hepatitis C infection after bone marrow transplantation
Long-term outcome of hepatitis C infection after bone marrow transplantation
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DOI：
10.1182/blood-2003-06-2145
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发表时间：
2004-03-01
期刊：
影响因子：
20.3
通讯作者：
Socié, G
中科院分区：
文献类型：
--
作者：
de Latour, RP;Lévy, V;Socié, G
慢性丙型肝炎通常是无症状的，至少在造血干细胞移植后的前十年是这样。目前认为存活超过 10 年的患者进展为晚期肝病或肝硬化的情况很少见。在1973年1月至1995年1月期间接受同种异体移植的1078名患者中，有96名患者在移植期间感染了丙型肝炎病毒（HCV）。对肝硬化的累积发生率和危险因素进行分析，并将移植受者的肝硬化发生率和风险与158名未接受移植的HCV感染对照进行比较。中位随访时间为 15.7 年，15 名患者出现活检证实的肝硬化，导致 15 年和 20 年肝硬化的累积发病率分别为 11% 和 24%。通过多变量分析，肝外 HCV 表现和 HCV 基因型 3 与肝硬化风险相关。移植受者出现肝硬化的中位时间为 18 年，而对照组人群为 40 年。通过多变量分析，移植受者的肝硬化风险相对于对照组显着更高 (P = .0008)。大约四分之一接受移植的长期 HCV 感染幸存者进展为肝硬化，其速度比未接受移植的患者快得多。因此，对于长期骨髓移植受者来说，有必要进行 HCV 感染的系统检测、肝活检和治疗干预。 (C) 2004 年，美国血液学会。
Chronic hepatitis C is often asymptomatic, at least during the first decade following hematopoietic stem cell transplantation. Progression to advanced liver disease or cirrhosis in patients surviving more than 10 years is currently thought to be rare. Among 1078 patients who underwent an allogeneic transplantation between January 1973 and January 1995, 96 patients infected by hepatitis C virus (HCV) during the transplantation period were studied. Cumulative incidence and analysis of risk factors for cirrhosis were analyzed, and the rate and risk of cirrhosis in transplant recipients were compared with those of 158 HCV-infected controls who did not receive transplants. At a median follow-up of 15.7 years, 15 patients developed biopsy-proven cirrhosis, leading to a cumulative incidence of cirrhosis of 11% and 24% at 15 and 20 years, respectively. By multivariate analysis, extrahepatic HCV manifestations and HCV genotype 3 were associated with risk of cirrhosis. The median time to cirrhosis in transplant recipients was 18 years as compared with 40 years in the control population. The risk of cirrhosis in transplant recipients relative to controls was significantly higher by multivariate analysis (P = .0008). Roughly a quarter of long-term HCV-infected survivors with transplants progressed to cirrhosis that is much more rapid than in patients without transplants. Systematic detection of HCV infection, liver biopsy, and therapeutic intervention are therefore warranted in long-term marrow transplant recipients. (C) 2004 by The American Society of Hematology.