肝炎病毒携带者肾移植后的处理

Treatment of the hepatic virus carriers receiving renal transplantation

目的探讨肝炎病毒携带者肾移植后的处理。方法14例患者中,8例感染乙型肝炎病毒(HBV),4例感染丙型肝炎病毒(HCV),2例同时感染HBV和HCV,移植术前肝炎病毒DNA或RNA阴性。结果术后随访3～20个月,10例患者于术后2周内出现程度不等的肝功能异常,均以丙氨酸转氨酶和天冬氨酸转氨酶升高为主,HBVDNA和/或HCVRNA均呈阴性,经调整免疫抑制剂用量,并给予护肝治疗,患者的肝功能均恢复正常。结论肝炎病毒携带者接受肾移植后,出现肝功能异常时,应正确区分系药物性肝损害还是病毒性肝损害,及时采取相应处理,并给予护肝治疗。

Objective To investigate the treatment of recipients carrying hepatic virus after renal transplantation. Methods Of the 14 patients, 8 carried HBV and 4 HCV, and the other 2 both HBV and HCV. HBV DNA or RNA was negative before transplantation. Results During the followup period of 3 to 20 months, 10 patients had liver dysfunction with higher ALT and AST, but negative for HBV DNA and/or HCV RNA. After adjusting the dosage of immunosuppressants and treatment of liver protection, liver function of these patients all restored to normal level. Conclusion In the hepatic virus carriers receiving renal transplantation, liver dysfunction caused by drug-induced liver damage or hepatic viral injury should be distinguished and corresponding treatment should be given in time.