乙型肝炎病毒和丙型肝炎病毒感染对肾移植受者存活的影响

目的探讨乙型肝炎病毒(HBV)和(或)丙型肝炎病毒(hepatitis C virus,HCV)感染对肾移植受者长期存活的影响及预防措施。方法 HBV和(或)HCV感染肾移植受者110例(感染组),其中HBV感染受者56例、HCV感染受者52例,HBV与HCV合并感染2例。非HBV与非HCV感染受者694例(非感染组)。感染组受者术前有病毒复制者予积极治疗,研究早期肝功能正常者可接受肾移植,后期均用聚合酶链反应(PCR)检测,要求连续3～6个月HBV脱氧核糖核酸(DNA)0copy/ml,HCV核糖核酸(RNA)0copy/ml方可接受肾移植。术后定期检测HBV与HCV,定期检测感染组受者HBVDNA滴度、HCVRNA滴度。发现HBV复制,选用拉米夫定、阿德福韦酯治疗,酌情减少免疫抑制剂用量。分别比较两组术后1、3、5年人、肾存活率,比较两组的肝功能衰竭病死率。结果非感染组人、肾存活率分别为:1年94.2%、91.4%,3年为86.4%、85.2%,5年为82.7%、78.9%;感染组人、肾存活率分别为:1年90.2%、88.1%,3年为88.9%、86.2%,5年为81.5%、76.3%;两组数据比较差异均无统计学意义(均为P>0.05)。感染组中14例(12.7%)死于肝功能衰竭,其中10例为HBV感染者,非感染组受者无1例死于肝衰竭。感染组术后肝衰竭病死率明显高于非感染组(12.7%、0,P<0.05)。结论受者术前HBV和(或)HCV感染会明显增加肾移植术后肝衰竭死亡危险。患者术前处于病毒复制期应予积极治疗,在肝炎病毒停止复制6个月后再考虑肾移植。长期随访中应定期复查HBV与HCV感染指标,早确诊、早治疗,并及时调整免疫抑制剂剂量。

Influence of hepatitis B virus and hepatitis C virus infection on the survival of renal transplant recipients

Objective To explore the influence of hepatitis B virus(HBV) and(or) hepatitis C virus(HCV) infection on the long range survival of the kidney transplant recipient,and their prevention.Methods One hundred and ten renal transplant recipients with HBV and(or) HCV infection were selected as infection group,in which 56 cases were HBV infection,52 cases were HCV infection and 2 cases were combined HBV and HCV infection.Six hundred and ninty-four recipients without HBV and HCV infection were selected as non-infection group.In infection group,recipients with virus replication were treated aggressively.In the early stage of the study,the recipients with normal liver function received renal transplantation.In the later stage of the study,HBV deoxyribonuleic acid(DNA) and HCV ribonucleic acid(RNA) were detected by polymerase chain reaction(PCR).Those with HBV DNA and HCV RNA 0 copy/ml for 3-6 months received renal transplantation.The postoperative titer of HBV DNA and HCV RNA in infection group were detected regularly.Lamivudine and adefovir dipivoxil were used and the dose of immunosuppressant was decreased in the condition that HBV replication was detected.The person/kidney survival rates were compared between the two groups at 1-,3-,5-year after transplantation.And the mortality of liver failure were also compared.Results In non-infection group,the postoperative person/kidney survival rates were 94.2% and 91.4% for 1 year,86.4% and 85.2% for 3 years,82.7% and 78.9% for 5 years,respectively.In infection group,the person/kidney survival rates were 90.2% and 88.1% for 1 year,88.9% and 86.2% for 3 years,81.5% and 76.3% for 5 years.There was no significant difference between the 2 groups(all in P>0.05).In infection group,14 recipients(12.7%) died of liver failure,in whom 10 cases were HBV infection.In non-infection group,no recipient died of liver failure.The mortality of liver failure in the infection group was significantly higher than that in non-infected group(12.7%,0,P<0.05).Conclusions Renal transplant candidate with HBV and(or) HCV infection would increase the risk of death for liver failure after transplantation.Preoperative aggressive treatment should be given to the recipients with virus replication.Renal transplantation should be considered 6 months after the replication ceased.In the long-term follow-up,HBV DNA and HCV RNA should be regularly examined for early final diagnosis,early treatment of the infection and adjustment of immunosuppressant doses.