transplantologiyaТрансплантологияTransplantologiya. The Russian Journal of Transplantation2074-05062542-0909IPO Association of Transplantologists10.23873/2074-0506-2010-0-3-4-37-45transplantologiya-293Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL INVESTIGATIONSДисфункция трансплантата печени, обусловленная инфекцией гепатита СLiver graft dysfunction due to hepatitis C infectionСюткинВ. Е.SyutkinV. E.

Владимир Евгеньевич Сюткин

Department of Transplantology and Artificial Organs

vsyutkin@rambler.ruАндрейцеваО. И.AndreitsevaO. I.

Department of Transplantology and Artificial Organs

ЧжаоА. В.ChzhaoA. V.

Department of Transplantology and Artificial Organs

НИИ скорой помощи им. Н.В. Склифосовского; МГМСУРоссияN.V. Sklifosovsky Research Institute of Emergency Care; Moscow State University of Medicine and DentistryRussian Federation20101708201803-43745Copyright © Сюткин В.Е., Андрейцева О.И., Чжао А.В., 20182018Сюткин В.Е., Андрейцева О.И., Чжао А.В.Syutkin V.E., Andreitseva O.I., Chzhao A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jtransplantologiya.ru/jour/article/view/293

Цель исследования – изучение характера послеоперационного течения инфекции, вызванной вирусом гепатита С (HCV), и выявление факторов, влияющих на прогноз болезни трансплантата.

Материалы и методы

Материалы и методы. Проанализированы данные о течении возвратной HCV-инфекции у 38 реципиентов, перенесших ортотопическую трансплантацию печени (ОТП) в Московском центре трансплантации печени за период с сентября 2000 по сентябрь 2010 г., переживших ранний послеоперационный период и не включенных в международные клинические испытания.

Результаты

Результаты. Возврат HCV-инфекции после ОТП наблюдался у всех больных, у которых РНК HCV присутствовала в крови до ОТП. В первый год после ОТП течение возвратной HCV-инфекции могло быть латентным или проявляться активным гепатитом. Активный прогрессирующий гепатит чаще развивался при наличии сопутствующей патологии трансплантата и/или при проведении пульс-терапии метилпреднизолоном. Независимо от течения HCV-инфекции (латентное, активное) гистологические признаки серьезного поражения печени к концу первого года после ОТП наблюдались у 3/4 больных, причем в 19% случаев имел место формирующийся цирроз печени. У большинства (5 (63%) из 8), больных, у которых в первый год после ОТП течение возвратной HCV-инфекции было латентным, к концу 2-го года после ОТП развивался активный прогрессирующий гепатит, который в отсутствие эффективной противовирусной терапии привел к смерти 2 (25%) из 8 больных, наблюдавшихся более 3 лет после ОТП. Фиброзирующий холестатический гепатит наблюдался нами в 5% случаев возвратной HCV-инфекции и привел к ретрансплантации печени или смерти пациентов.

Заключение

Заключение. Возврат HCV-инфекции после ОТП наблюдался у всех больных, у которых РНК HCV присутствовала в крови до операции. Характер течения возвратной HCV-инфекции в первый год после ОТП зависел от сопутствующей патологии трансплантата печени и ее лечения. У большинства больных к концу 2-го года после ОТП развивался активный прогрессирующий гепатит.

We analyzed natural history of recurrent HCV-infection after cadaveric liver transplantation (LTx) in 38 cases. The mean follow-up time was 23.8 (95% CI, 18.4; 29.2) mo after LTx. There were latent course in 19 pts, and active hepatitis in another 19 pts in the 1st post-LTx year. Active hepatitis has been associated with CMV-infection, acute cellular rejection and methylprednisolon pulse-therapy. Liver biopsy had shown advanced fibrosis or cirrhosis in 19% cases independently on latent or active course. In 5 out 8 pts with latent course of HCV-infection in the 1st y., the active hepatitis developed up to the end of the 2nd y. FU. Two cases of fibrosing cholestatic hepatitis resulted in the death or retransplantation. Two cases of unusual course of recurrent HCV-infection described (i.e. fulminant liver failure without cholestasis).

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The authors declare that there are no conflicts of interest present.