De Vera M E, Smallwood G A, Rosado K, Davis L, Martinez E, Sharma S, Stieber A C, Heffron T G
Department of Surgery, Emory University Medical School, Atlanta, Georgia 30322, USA.
Transplantation. 2001 Mar 15;71(5):678-86. doi: 10.1097/00007890-200103150-00019.
Initial studies utilizing interferon-alpha and ribavirin for the treatment of recurrent hepatitis C virus (HCV) infection after liver transplantation showed promising results. Here we report our single-center experience using this combination therapy.
Liver transplant recipients with recurrent HCV (elevated serum aminotransferases, positive serum HCV RNA, and biopsy-proven hepatitis without rejection) received interferon-alpha (1.5-3 million units subcutaneously three times a week) and ribavirin (400-1000 mg p.o. daily) for 12 months or more. Serum aminotransferases, HCV RNA, and severity of hepatitis were followed.
Thirty-two patients have been treated for at least 3 months, including 13 who have been on 12 or more months of therapy. Three died from allograft failure due to recurrent HCV. Dose reductions of interferon-alpha and/or ribavirin occurred in 22 patients. Thirteen had their medications permanently discontinued for severe adverse effects. Twenty-six patients (81%) had a biochemical response (BR; normalization of serum aminotransferases) after 3 months. End-of-treatment and sustained BR were 77% and 71%, respectively. Mean viral loads decreased 68-77%; however, only three patients became serum HCV RNA negative. After 12 months of therapy, no histological improvement was observed in 11 patients who were biopsied. Patients who received mycophenolate mofetil or daclizumab had a less likelihood of achieving a BR.
A significant number of patients did not tolerate interferon-alpha or ribavirin. Although BR was excellent and mean viral loads decreased significantly, virological clearance was poor and no histological improvement was noted. A more efficacious treatment with less adverse effects for recurrent HCV after liver transplantation is needed.
最初使用干扰素-α和利巴韦林治疗肝移植后复发性丙型肝炎病毒（HCV）感染的研究显示出了有前景的结果。在此，我们报告我们使用这种联合疗法的单中心经验。
复发性HCV的肝移植受者（血清转氨酶升高、血清HCV RNA阳性且经活检证实为无排斥反应的肝炎）接受干扰素-α（皮下注射150 - 300万单位，每周三次）和利巴韦林（口服400 - 1000毫克，每日一次）治疗12个月或更长时间。随访血清转氨酶、HCV RNA及肝炎严重程度。
32例患者接受治疗至少3个月，其中13例接受治疗12个月或更长时间。3例因复发性HCV导致移植肝失功死亡。22例患者减少了干扰素-α和/或利巴韦林的剂量。13例因严重不良反应而永久停药。26例患者（81%）在3个月后出现生化反应（BR；血清转氨酶恢复正常）。治疗结束时和持续BR分别为77%和71%。平均病毒载量下降68 - 77%；然而，只有3例患者血清HCV RNA转为阴性。治疗12个月后，11例接受活检的患者未观察到组织学改善。接受霉酚酸酯或达利珠单抗的患者实现BR的可能性较小。
大量患者不能耐受干扰素-α或利巴韦林。尽管BR良好且平均病毒载量显著下降，但病毒学清除率较差且未观察到组织学改善。需要一种对肝移植后复发性HCV更有效且不良反应更少的治疗方法。
