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1996年元月至1998年6月我院24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14例接受肾移植并对其进行长期随访。结果：24例患者肝活检的成功率100％。并发症的发生率为33.3％，需输血治疗者4例(16.7％)；无一例需手术治疗或死亡。24例患者中，明确诊断为慢性乙型肝炎者11例、丙型肝炎11例、2例乙肝合并丙肝。18例患者(75.0％)病理表现为慢性迁延性肝炎；4例(16.7％)为慢性活动性肝炎；2例(8.3％)为小结节性肝硬化。14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10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，14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。慢性迁延性肝炎患者接受肾移植后，肝脏病变仍可进行性发展。采用MMF预防排斥反应有利于减少术后并发症，提高肾移植患者的远期存活率。%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 percu-taneous liver biopsy performed in 24 transplantation candidates and analyze its impact on the clinical treatment and prognosis inthose 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, 14of 24 received renal transplants. RESULTS After liver biopsy,4 of 24 patrents developed hypotention related to the procedureand 4 developed an intra-abdominal hemonhage 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 morphologicdiagnosis 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 followup of 35.9 months,3 patients died of hepatic failure and CMV infection. CONCLUSION Liver biopsy is safe and of clinicalvalue in hemodialysis patients with chronic hepatitis prior to renal transplantation. Close followup after transplantation is requiredin view of the increased risk for hepatic failure and infection.
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