丙型肝炎病毒阳性受者肾移植后的安全性分析

Safety analysis on kidney transplantation in hepatitis C virus-positive patients

背景：对于丙肝病毒阳性患者接受肾移植后安全性的问题是目前大家关注的热点。目的：丙型肝炎病毒感染者接受肾移植后临床观察及处理对策。方法：纳入22例患者,肾移植前肝炎病毒RNA均为阳性,其中14例患者肝功能轻度升高。移植后定期检测患者的肝、肾功能,积极防治可能的排斥反应。主要观察患者一般情况、肝、肾功能、肝炎病毒基因学情况及死亡率。结果与结论：移植后随访6~36个月,20例患者移植后4周~6个月内出现不同程度的肝功能异常,予护肝治疗后肝功能均恢复正常,1例移植后HCV-RNA阳性患者,因自行改变抗排斥方案于移植后1.5年出现严重的肝功能衰竭而死亡;4例患者移植后应用干扰素和利巴韦林治疗,HCV-RNA转阴,其余18例患者HCV-RNA均呈阳性,需长期护肝治疗。表明,对丙肝病毒阳性受者,移植后应进行严格的随访,出现肝功能异常时,及时采取相应处理和护肝治疗。

BACKGROUND：Safety of kidney transplantation in hepatitis C virus （HCV）-positive patients has been paid increasing attention. OBJECTIVE：To study the clinical observation and treatment strategy in HCV RNA-positive patients after kidney transplantation. METHODS：A total of 22 HCV RNA-positive patients were involved in this study, of which 14 patients had mild liver dysfunction. The patients＇ liver and kidney function were detected regularly and corresponding doses and types of the anti-immune rejection drug were adjusted in time to prevent possible immunological rejections. RESULTS AND CONCLUSION：During the postoperative follow-up period of 6-36 months, 20 patients presented with different degrees of liver dysfunction at 4 weeks-6 months. After drug treatment, liver function recovered to normal level. At 1.5 years after kidney transplantation, one patient died of severe liver failure due to changing his anti-rejection program by himself.Four patients presented with HCV RNA-negative symptoms after using interferon combined with ribavirin after kidney transplantation, while the remaining 18 patients remained to present HCV RNA-positive symptoms and required long-term liver treatment. These findings suggest that HCV-positive recipients should be strictly followed up after kidney transplantation to ensure that appropriate managements would be taken in time when their liver function appeared abnormal.