The association between hepatitis C infection and survival after orthotopic liver transplantation
The association between hepatitis C infection and survival after orthotopic liver transplantation
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DOI：
10.1053/gast.2002.32418
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发表时间：
2002-04-01
期刊：
影响因子：
29.4
通讯作者：
Lucey, MR
中科院分区：
文献类型：
--
作者：
Forman, LM;Lewis, JD;Lucey, MR
背景和目标：丙型肝炎病毒（HCV）感染对原位肝移植术后患者和移植物存活的影响存在争议。移植后丙型肝炎复发是不可避免的，但迄今为止的研究还没有发现有和没有丙型肝炎病毒的受体之间的生存差异。研究方法：利用来自器官共享联合网络的数据，我们对1992年至1998年间接受11,791例肝移植的11,036例患者进行了回顾性队列研究。通过比例风险分析评估HCV阳性患者与HCV阴性患者的患者和同种异体移植物存活率的风险率，并调整潜在的混杂变量，包括供体、受体和移植中心的特征。结果如下：与HCV阴性受者相比，HCV阳性受者的肝移植与死亡率（危害比，1.23; 95%可信区间[CI]，1.12-1.35）和同种异体移植失败率（危害比，1.30; 95% CI，1.21-1.39）增加相关。在调整潜在混杂因素后，这种生存率的降低持续存在。HCV与性别之间存在相互作用（P < 0.001），HCV对女性受者生存率的影响最为显著（患者生存风险比，1.56; 95% CI，1.35-1.81;同种异体移植物生存风险比，1.51; 95% CI，1.34-1.70）。结论：HCV感染显著损害肝移植术后患者和移植物的存活。
Background & Aims: The effect of hepatitis C viral (HCV) infection on patient and allograft survival after orthotopic liver transplantation is controversial. Hepatitis C recurrence after transplant is inevitable, but studies to date have not found a survival difference between recipients with and without HCV. Methods: Using data from the United Network for Organ Sharing, we performed a retrospective cohort study of 11,036 patients who underwent 11,791 liver transplants between :1992 and 1998. The hazard rates of patient and allograft survival for patients who were HCV-positive as compared with patients who were HCV-negative were assessed by proportional-hazards analysis, with adjustment for potential confounding variables, including donor, recipient, and transplant center characteristics. Results: Liver transplantation in HCV-positive recipients was associated with an increased rate of death (hazard ratio, 1.23; 95% confidence interval [CI], 1.12-1.35) and allograft failure (hazard ratio, 1.30; 95% Cl, 1.21-1.39), as compared with transplantation in HCV-negative recipients. This reduction in survival persisted after adjusting for potential confounders. There was an interaction between HCV and sex (P < 0.001) with the effect of HCV on survival being most pronounced in female recipients (patient survival hazard ratio, 1.56; 95% Cl, 1.35-1.81; allograft survival hazard ratio, 1.51; 95% Cl, 1.34-1.70). Conclusions: HCV infection significantly impairs patient and allograft survival after liver transplantation.