RESUMEN
O verdadeiro papel do transplante renal na progressão da fibrose hepática causada pelo vírus da hepatite C ainda é imprevisível. A avaliação histológica do fígado é a melhor forma para estimar a evolução da fibrose, embora a análise semiquantitativa traz limitações importantes. Objetivo: aplicar um ensaio morfométrico quantitativo sobre a progressão da fibrose hepática em pacientes renais crônicos com hepatite C. Métodos: trinta pacientes foram inicialmente avaliados, mas apenas sete foram incluídos. Eles foram submetidos à primeira biópsia perto da data do transplante e a segunda biópsia, pelo menos, quatro anos mais tarde. A terapia imunossupressora adotada em todos os casos foi a azatioprina e micofenolato. A taxa de progressão da fibrose (FPR) foi calculada antes e após a data da cirurgia de cada paciente, de acordo com a classificação de Metavir pontuação e análise morfométrica. Resultados: a FPR calculada pelo escore Metavir não mostrou diferença estatística entre pré e pós-transplante (p = 0,9). A FPR calculada pela análise morfométrica foi de 0,58 ± 0,78 antes do transplante e 3,0 ± 3,3 após a cirurgia, com significância estatística entre estes valores (p = 0,0026). Conclusão: na amostra avaliada, a progressão da fibrose hepática foi documentada e quantificada apenas pela análise morfométrica, que é uma abordagem promissora para avaliação histológica desses pacientes.
The real role of renal transplantation in hepatic fibrosis progression caused by hepatitis C virus is still unpredictable. Histological evaluation of the liver is the best form to estimate fibrosis evolution, although semiquantitative analysis carries important limitations. Objective: to apply a morphometric quantitative assay on hepatic fibrosis progression in renal recipients with hepatits C. Methods: thirty patients were initially evaluated, but only seven were included. They underwent the first biopsy near the transplantation date and the second biopsy at least 4 years later. The immunosuppressant therapy adopted in all cases was azatioprine and micofenolate. Fibrosis progression rate (FPR) was calculated before and after the surgery date in each patient according to Metavir score and morphometric analysis. Results: the FPR calculated by Metavir score showed no statistical difference between pre- and post-transplantation (p=0.9). The FPR calculated by the morphometric analysis was 0.58 ± 0.78 before transplantation and 3.0 ± 3.3 after the surgery, with statistical signifycance between these values (p=0.0026). Conclusion: in the sample assessed, the progression of hepatic fibrosis was documented and quantified only by the morphometric analysis, which is as a promising approach to histological evaluation of these patients.
Asunto(s)
Humanos , Masculino , Femenino , Trasplante de Riñón , Hepatitis C Crónica , Cirrosis Hepática , Biopsia , Fibrosis , Estudios Retrospectivos , Factores de RiesgoRESUMEN
The purpose of this article was to report a series of 23 renal transplant recipients with histologically proven and immunohistochemically confirmed cytomegalovirus (CMV) lesions in the gastrointestinal tract (GIT) and to assess the risk factors associated with severe disease/mortality. CMV patients (n=23) were allocated into two groups: those who died (n=6) and those considered cured (n=17). Overall mortality rate was 26% (6/23). Initial symptoms suggestive of lower GIT involvement were observed in all death cases and in 35.3% of those cured (p=0.01). Enterorrhagia was seen in 83.3% of the patients who died. Death risk increased twofold (RR 2 [1.13-3.52], p=0.01) when symptoms of lower GIT involvement were initially observed and sixfold when enterrohagia was present (RR 6 [1.1-35.9], p=0.001). Among death cases, mean time at diagnosis was significantly more distant (2002±2.9×2008±1.6, p=0.04). The difference in mortality rates seen as service practices changed along the years demonstrates the importance of early diagnosis.
