肾移植供者丙型肝炎病毒(HCV)感染状况及移植抗HCV阳性供肾对受者的影响

目的了解肾移植供者丙型肝炎病毒(HCV)的感染率及移植抗HCV阳性供肾对受者的影响.方法采用酶联免疫吸附(ELISA)法检测肾移植供、受者的抗HCV;巢式多聚酶链反应(Nest-PCR)法检测HCVRNA;根据供、受者HCV状态将受者分为4组,对各组受者进行1年以上的随访研究.结果(1)供者HCV的感染率为4.35%;(2)抗HCV阴性的受者,接受抗HCV阳性供肾移植后,有62.5%的抗HCV及HCVRNA转为阳性,术后丙氨酸转氨酶(ALT)水平和肝功能损害发生率明显高于无HCV感染组;(3)将抗HCV阳性的供肾移植给抗HCV阳性的受者,与抗HCV阴性的受者接受抗HCV阳性供肾移植以及与抗HCV阳性的受者接受抗HCV阴性供肾的临床效果相同.结论(1)移植抗HCV阳性供肾能传播HCV,可影响受者的肝脏病变,但这种影响程度较轻;(2)将抗HCV阳性供肾移植给抗HCV阳性的受者,既不增加传播HCV的危险性,又能扩大供肾来源,是解决我国供肾短缺的一项值得考虑的策略.

The hepatitis C virus (HCV) infection status of donor and the impact of transplantation of kidneys from donors with anti-HCV antibody into recipients without anti-HCV

Objectives To evaluate the rate of hepatitis C virus (HCV) infection in donor and the impact of transplantation of kidneys from donors with anti-HCV into recipients without anti-HCV.Methods Anti-HCV and HCV RNA of the sera from kidney donors and recipients were tested using second generation ELISA and Nest-PCR respectively. The recipients according to the HCV infection status were divided into 4 groups and followed up for more than one year.Results The rate of HCV infection in the donors was 4.35 %; Anti-HCV and HCV RNA of 62.5 % of the recipients became positive in the patients without anti-HCV who received kidneys withanti-HCV, and ALT levels and prevalence of liver dysfunction in these patients were significantly higher than those without HCV infection. The outcome of recipients with anti-HCV receiving kidneys with anti-HCV was the same as that of the patients with anti-HCV receiving kidneys without anti-HCV. Conclusions Transplantation of kidneys with anti-HCV can transmit HCV, and result in mild liver disease. It is a considerable way using kidneys from the anti-HCV positive donors in the anti-HCV positive recipients.