Natural History of Post-Liver Transplantation Hepatitis C: A Review of Factors That May Influence Its Course
Natural History of Post-Liver Transplantation Hepatitis C: A Review of Factors That May Influence Its Course
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DOI：
10.1002/lt.21954
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发表时间：
2009-12-01
影响因子：
4.6
通讯作者：
Vargas, Hugo E.
中科院分区：
文献类型：
--
作者：
Gallegos-Orozco, Juan F.;Yosephy, Amir;Vargas, Hugo E.
我们的目的是评估HCV相关终末期肝病（ESLD）移植患者的长期生存率，并评估潜在的可改变的生存预测因子。我们做了一个。回顾性分析成人肝移植（LT）在我们的机构HCV相关的ESLD自该计划的开始。从电子病历中检索相关的人口统计学、临床和生化信息，并收集990例符合方案的肝活检组织学数据。在研究期间，我们的机构进行了380例LT，206例患者因HCV相关的ESLD接受移植; 6例在移植后30天内死亡，未纳入。其余200例接受者（DDLT 168例，LDLT 32例）构成可评价人群。人口统计学数据如下：150名男性，中位年龄53岁;中位供体年龄39岁; 26%的肝细胞癌（HCC）。总体1年、5年和7年生存率：95%、81%和79%;中位生存期43个月，死亡率15%。49%的患者出现明显的HCV复发（HAI ≥ 6和/或纤维化≥ 2），30.5%出现“早期复发”（LT后1年内），27%出现活检证实的急性排斥反应。对患者生存率有显著负面影响的因素包括：12个月活检时纤维化分期>= 2，供体年龄较大，HCC病史和早期急性排斥反应。无论供体类型如何，生存率相似（DDLT vs. LDLT）。早期和侵袭性HCV复发对患者生存率有非常严重的影响。及时识别和治疗“快速纤维化”可能会带来好处。如前所述，避免排斥反应和选择年轻供体作为HCV阳性受者也将提高这一人群的生存率。根据我们的研究结果，LDLT是HCV阳性受者的良好选择。肝移植15：1872-1881，2009。(C)2009年AASLD。
Our aim was to assess long-term survival in patients transplanted for HCV-related end-stage liver disease (ESLD) and evaluate potentially modifiable predictors of survival. We performed a. retrospective analysis of adult liver transplants (LT) at our institution for HCV-related ESLD since the program's inception. Pertinent demographic, clinical, and biochemical information was retrieved from electronic medical records and histological data from 990 per-protocol liver biopsies were collected. Three hundred eighty LT were performed at our institution during the study period, 206 patients were transplanted for HCV-related ESLD; 6 died within 30 days of transplantation and were not included. The remaining 200 recipients (DDLT 168 LDLT 32) constituted the evaluable population. The demographics were as follows: 150 males, median age 53 years; median donor age 39 years; hepatocellular carcinoma (HCC) in 26%. Overall 1-, 5-, and 7-year survival: 95%, 81%, and 79%; median survival 43 months, mortality 15%. Significant HCV recurrence (HAI >= 6 and/or fibrosis >= 2) was present in 49%, "early recurrence" (within 1 year of LT) in 30.5% and biopsy-proven acute rejection was present in 27%. Factors with a significant negative impact on patient survival included: fibrosis stage >= 2 at 12-month biopsy, advanced donor age, history of HCC and early acute rejection. Survival was similar regardless of the donor type (DDLT vs. LDLT). Early and aggressive HCV recurrence has a very heavy toll on patient survival. Prompt recognition and treatment of "rapid fibrosers" may impart benefit. As has been described before, avoidance of rejection and selection of young donors for HCV-positive recipients will also improve survival in this population. On the basis of our findings, LDLT is a good option for HCV-positive recipients. Liver Transpl 15:1872-1881, 2009. (C) 2009 AASLD.