Dumortier Jérôme, Scoazec Jean-Yves, Chevallier Philippe, Boillot Olivier
Unité de transplantation hépatique-Fédération des Spécialités Digestives, Hôpital Edouard Herriot, 69437 Lyon Cedex 03, France.
J Hepatol. 2004 Apr;40(4):669-74. doi: 10.1016/j.jhep.2003.12.015.
BACKGROUND/AIMS: After liver transplantation (LT) for HCV-related cirrhosis, recurrence of HCV infection is universal and the risk of progression to cirrhosis is high. The modalities and efficacy of antiviral therapy in this indication are still controversial. We present here the results of a pilot study of a 12-month combination therapy by pegylated alfa 2b-interferon (PEG-IFN) and ribavirin in 20 patients.
Twenty patients entered the study (13 male and 7 female, median age 53.8 years). In 80% of patients, HCV infection was of genotype 1. The delay between LT and antiviral therapy was 28 months. The doses were progressively increased from 0.5 to 1 micro g/kg/week for PEG-IFN and from 400 to 1000-1200 mg/d for ribavirin. Follow-up was based on biochemical (ALT), virological (HCV-RNA) and histological (liver biopsy) examinations.
Four patients (20%) were withdrawn due to adverse effects. In 6 patients the dose of PEG-IFN had to be reduced to 0.5 micro g/kg/week. A reduction in the dose of ribavirin in 13/16 cases was due to the onset of anemia. Histological evidence of mild acute rejection increased the immunosuppressive regimen in 5/20 patients. At the end of the treatment, 75% of the patients had a biochemical response and 55% a virological response. The mean METAVIR score, according to activity and fibrosis, was A1.8 F2.2 before treatment and A0.3 F1.6 at the end of treatment. In 9/20 patients, virological response persisted 6 months after the end of the treatment.
Our results suggest that combination therapy by PEG-IFN and ribavirin may be well tolerated and beneficial during recurrent hepatitis C in liver transplant recipients.
背景/目的：对于丙型肝炎病毒（HCV）相关性肝硬化患者进行肝移植（LT）后，HCV感染复发普遍存在，且进展为肝硬化的风险很高。针对该适应证的抗病毒治疗方式及疗效仍存在争议。我们在此展示一项针对20例患者进行的为期12个月的聚乙二醇化α-2b干扰素（PEG-IFN）联合利巴韦林治疗的初步研究结果。
20例患者进入研究（13例男性，7例女性，中位年龄53.8岁）。80%的患者HCV感染为1型基因型。LT与抗病毒治疗之间的间隔为28个月。PEG-IFN剂量从0.5μg/kg/周逐渐增加至1μg/kg/周，利巴韦林剂量从400mg/d增加至1000 - 1200mg/d。随访基于生化检查（ALT）、病毒学检查（HCV-RNA）和组织学检查（肝活检）。
4例患者（20%）因不良反应退出。6例患者的PEG-IFN剂量不得不降至0.5μg/kg/周。16例中有13例因贫血发作而降低了利巴韦林剂量。5/20例患者出现轻度急性排斥反应的组织学证据，这使得免疫抑制方案得以加强。治疗结束时，75%的患者有生化反应，55%有病毒学反应。根据活动度和纤维化程度，治疗前平均METAVIR评分为A1.8 F2.2，治疗结束时为A0.3 F1.6。9/20例患者在治疗结束后6个月仍持续有病毒学反应。
我们的结果表明，PEG-IFN联合利巴韦林的联合治疗在肝移植受者复发性丙型肝炎期间可能耐受性良好且有益。
