Histological recurrence and progression of hepatitis C after orthotopic liver transplantation: Influence of immunosuppressive regimens

被引:38
作者
Hunt, J
Gordon, FD
Lewis, WD
Pomfret, E
Pomposelli, JJ
Jenkins, RL
Khettry, U
机构
[1] Lahey Clin Med Ctr, Dept Pathol Anat, Burlington, MA 01805 USA
[2] Lahey Clin Med Ctr, Hepatobiliary & Liver Transplantat Div, Burlington, MA 01805 USA
[3] Beth Israel Deaconess Med Ctr, Dept Pathol, Boston, MA 02215 USA
关键词
D O I
10.1053/jlts.2001.27803
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Post-orthotopic liver transplantation (OLT) recurrence of hepatitis C is virtually universal, but histological progression of disease is not. This study examines long-term clinical and liver histological features at and after OLT to elucidate factors predictive of hepatitis C recurrence and progression after OLT. A blinded retrospective review of clinical, serological, and histopathologic features of 65 patients who underwent OLT for hepatitis C and Non A Non B hepatitis was conducted. Histological findings of recurrent hepatitis C and progression (fibrosis, greater than or equal to grade 2 by last follow-up) were correlated with clinical parameters. Histological recurrence of hepatitis C was seen in 43 of 65 patients, with progression in 19 patients. Histological findings in the native liver and post-OLT biopsy specimen at the time of recurrence showed no correlation with hepatitis C recurrence and progression. Patients treated with azathioprine (AZA)-containing immunosuppressive regimens experienced less recurrence (6 of 17 v 37 of 48 patients; P < .005) and progression (1 of 17 v 18 of 48 patients; P = .014) than those without AZA as part of their immunosuppressive regimen. No difference was seen between patients treated with cyclosporine versus those administered FK506 (P > .05). Histological recurrence of hepatitis C after OLT is seen in 66% of patients with progressive disease and 29% of all patients. The grade of inflammation in the native liver at the time of OLT and time of recurrence is not predictive of progression. AZA-containing regimens reduce histological recurrence and progression of hepatitis C in post-OLT patients.
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页码:1056 / 1063
页数:8
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