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肝移植受者接受干扰素治疗后急性排斥反应的结局

Outcomes of acute rejection after interferon therapy in liver transplant recipients.

作者信息

Saab Sammy, Kalmaz Denise, Gajjar Nupoor A, Hiatt Jonathan, Durazo Francisco, Han Steven, Farmer Douglas G, Ghobrial R Mark, Yersiz Hasan, Goldstein Leonard I, Lassman Charles R, Busuttil Ronald W

机构信息

Department of Medicine, Dumont-UCLA Liver Transplant Center, Los Angeles, CA, USA.

出版信息

Liver Transpl. 2004 Jul;10(7):859-67. doi: 10.1002/lt.20157.

Abstract

Interferon alfa has been increasingly used against recurrent hepatitis C (HCV) disease in post-liver transplant (LT) recipients. A serious potential adverse effect is acute rejection. We reviewed our experience using interferon-based therapy (interferon or pegylated interferon with or without ribavirin) for treating recurrent HCV in LT recipients. Forty-four LT recipients were treated with interferon for recurrent HCV. Five of the 44 patients developed acute rejection during interferon-based therapy. These 5 patients started treatment of 42.4 +/- 33.89 months (mean +/- SD) after LT. Mean (+/- SD) histological activity index and fibrosis scores before initiating antiviral therapy were 8.8 (+/- 1.92) and 2.6 (+/- 0.55), respectively. Patients were treated for 3.3 +/- 2.28 months (mean +/- SD) prior to rejection. At the time of rejection, HCV load was not detectable in 4 of the 5 recipients. All 5 patients had tolerated interferon therapy, and none had stopped therapy because of adverse effects. The rejection was successfully treated in 3 patients. In 2 of those 3 patients, cirrhosis eventually developed. In the 2 patients who did not respond to rejection treatment, immediate graft failure occurred, leading to re-LT in 1 patient and death from sepsis in the other. In conclusion, the results indicate that further studies are needed to assess the safety of interferon in LT recipients. Interferon-based therapy may lead to acute rejection and subsequent graft loss and should therefore be used with caution. Treated recipients may also develop progressive cirrhosis despite achieving a sustained virological response.

摘要

干扰素α已越来越多地用于治疗肝移植后复发性丙型肝炎(HCV)疾病。一个严重的潜在不良反应是急性排斥反应。我们回顾了我们使用基于干扰素的疗法(干扰素或聚乙二醇化干扰素联合或不联合利巴韦林)治疗肝移植受者复发性HCV的经验。44例肝移植受者接受干扰素治疗复发性HCV。44例患者中有5例在基于干扰素的治疗期间发生急性排斥反应。这5例患者在肝移植后42.4±33.89个月(均值±标准差)开始治疗。开始抗病毒治疗前的平均(±标准差)组织学活动指数和纤维化评分分别为8.8(±1.92)和2.6(±0.55)。患者在发生排斥反应前接受治疗3.3±2.28个月(均值±标准差)。在发生排斥反应时,5例受者中有4例检测不到HCV载量。所有5例患者均耐受干扰素治疗,且均未因不良反应而停止治疗。3例患者的排斥反应得到成功治疗。在这3例患者中的2例最终发展为肝硬化。在2例对排斥反应治疗无反应的患者中,立即发生移植肝功能衰竭,导致1例患者再次肝移植,另1例患者死于败血症。总之,结果表明需要进一步研究以评估干扰素在肝移植受者中的安全性。基于干扰素的疗法可能导致急性排斥反应及随后的移植肝丢失,因此应谨慎使用。尽管实现了持续病毒学应答,接受治疗的受者仍可能发展为进行性肝硬化。

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