与尸体肝移植相比活体肝移植后患者丙型肝炎的复发更为严重

作     者：Garcia-Retortillo M. Forns X. Llovet J.M. 樊菁 

作者机构：Liver Unit I nstitut de Malalties Digestives Hospital Clinic Villarroel 170 Barcelona 080 36 SpainDr. 

出 版 物：《世界核心医学期刊文摘（胃肠病学分册）》 (Core Journals in Gastroenterology)

年 卷 期：2005年第1卷第2期

页      面：42-42页

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：活体肝移植 丙型肝炎 胆管并发症 移植术 侵袭力 移植物 评定过程 单变量分析 单中心 

摘      要：Preliminary reports suggested that hepatitis C virus (HCV) infection has a mor e aggressive course following living donor liver transplantation (LDLT) compared to cadaveric liver transplantation (CLT). The aim of this prospective study was to establish if HCV disease recurrence differs between LDLT and CLT. A cohort o f 116 consecutive HCV-infected patients undergoing 117 LTs in a single center f rom March 2000 to August 2003 were followed-up, including systematic liver biop sies. Severe recurrence (SR) was defined as biopsy-proven cirrhosis and/or the occurrence of clinical decompensation. After a median follow-up of 22 months (2 .6-44months), 26 (22%) patients developed SR(decompensation in 12), involving 17 (18%) of 95 patients undergoing CLT and 9 (41%) of 22 undergoing LDLT. The 2-year probability of presenting SR was significantly higher in LDLT compared t o CLT (45%vs. 22%, P = .019). By univariate analysis LDLT (P = .019) and an AL T higher than 80 IU/L 3 months after LT (P = .022) were predictors of SR. In 93 patients from whom a liver biopsy was available 3 months after LT, a lobular nec roinflammatory score 1 (P , = 2.8; 95%CI, 1.19-6.6; P = .024) a nd a lobular necroinflammatory score 1 (OR, 3.1; 95%CI, 1.2-8; P = .013). In conclusion, HCV recurrence is more severe in LDLT compared to CLT. Although our results were based on a single-center experience, they should be considered in the decision-making process of transplant programs, since severe HCV recurrenc emay ultimately compromise graft and patient survival.