慢性肝炎受者肾移植术前肝活检的临床价值

LIVER BIOPSY IN CANDIDATE RENAL GRAFT RECIPIENTS WITH CHRONIC HEPATITIS

目的 :了解慢性肾衰 (CRF)合并病毒性肝炎患者肾移植前进行肝活检的安全性及临床价值。 方法 :分析 1 996年元月至 1 998年 6月我院 2 4例CRF合并慢性病毒性肝炎患者肾移植前行经皮肝活检的安全性及组织病理结果。其中 1 4例接受肾移植并对其进行长期随访。 结果 :2 4例患者肝活检的成功率 1 0 0 %。并发症的发生率为 33 3% ,需输血治疗者 4例 (1 6 7% ) ;无一例需手术治疗或死亡。 2 4例患者中 ,明确诊断为慢性乙型肝炎者 1 1例、丙型肝炎 1 1例、2例乙肝合并丙肝。 1 8例患者 (75 0 % )病理表现为慢性迁延性肝炎 ;4例 (1 6 7% )为慢性活动性肝炎 ;2例 (8 3% )为小结节性肝硬化。 1 4例组织学诊断为慢性迁延性肝炎的患者分别在肝活检后 1～ 8个月接受了肾移植。其中乙肝 7例 ,丙肝 6例 ,乙肝伴丙肝 1例。术后有 1 0例接受CsA +MMF +Pred ,4例接受CsA+AZA +Pred三联免疫抑制治疗。肾移植后平均随访 35 9个月 ,1 4例患者中 3例死亡 (2例肝衰 ,均为乙肝 ;1例CMV感染 ) ;3例因慢性排斥重新接受血透。移植肾有功能的 8例患者中 ,6例肾功能持续正常 ,2例伴有慢性排斥。 结论 :CRF合并慢性肝炎患者肾移植前肝活检是有必要的 ,可以发现不宜行肾移植的慢性活动性肝炎、肝硬化等病变。

OBJECTIVE Evaluation of chronic hepatitis in renal graft recipient candidates is of clinical value in decision of transplantation,choice of immune suppressive regimes and prognosis after transplantation.In this study,we report our experience with percutaneous liver biopsy performed in 24 transplantation candidates and analyze its impact on the clinical treatment and prognosis in those received renal allografts. METHODOLOGY Between January 1996 to June 1998,24 hemodialysis patients with hepatitis(22 men and 2 women) underwent diagnostic liver biopsy prior to renal transplantation at Jinling hospital.After the liver biopsy,14 of 24 received renal transplants. RESULTS After liver biopsy,4 of 24 patrents developed hypotention related to the procedure and 4 developed an intra abdominal hemorrhage that did not require surgical intervention.Eleven of the 24 patients were seropositive for only HBsAg,11 were positive only for HCV RNA,2 of the 24 has HBsAg and HCV RNA concomitantly.The morphologic diagnosis included chronic persistent hepatitis in 18(75%),chronic active hepatitis in 4(16.7%),and cirrhotic hepatitis in 2 (8.3%) patients.Fourteen of the 18 patients with chronic persistent hepatitis has received renal transplants.The standard immunosuppressive therapy consisted of CsA,Pred,MMF in 10 patients,or CsA,Pred AZA in the other 4 patients.During a mean follow-up of 35.9 months,3 patients died of hepatic failure and CMV infection. CONCLUSION Liver biopsy is safe and of clinical value in hemodialysis patients with chronic hepatitis prior to renal transplantation.Close follow-up after transplantation is required in view of the increased risk for hepatic failure and infection.