Sugawara Yasuhiko, Makuuchi Masatoshi, Matsui Yuichi, Kishi Yoji, Akamatsu Nobuhisa, Kaneko Junichi, Kokudo Norihiro
Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Transplantation. 2004 Nov 15;78(9):1308-11. doi: 10.1097/01.tp.0000142677.12473.e5.
Living-donor liver transplantation (LDLT) is important for patients with end-stage viral hepatitis because of the cadaveric organ shortage. Preliminary results, however, indicate that LDLT might be disadvantageous for patients positive for hepatitis C virus (HCV).
The subjects were 23 patients who underwent LDLT for HCV cirrhosis. All the patients preemptively received antiviral therapy consisting of interferon-alfa2b and ribavirin, which was started approximately 1 month after the operation. The therapy continued for 12 months after the first negative HCV RNA test. The patients were then observed without the therapy for 6 months (group 1). The therapy was continued for at least 12 months even when the HCV RNA test remained positive (group 2). The subjects were removed from the protocol if they could not continue the therapy for 12 months because of adverse effects or could not start the therapy because of early death.
Eight patients were removed from the protocol. Nine patients were assigned to group 1 and the other six to group 2. The sustained virologic response ratio was 39% (9 of 23). There was a significant difference between the groups in the histologic activity score 1 year after the therapy. The cumulated 3-year survival of the HCV-positive patients was 85%, which was comparable with that of patients negative for HCV (n=93 [90%]).
The present preemptive antiviral protocol after LDLT is safe and might warrant a controlled study for confirming its benefit on graft survival.
由于尸体器官短缺，活体供肝肝移植（LDLT）对于终末期病毒性肝炎患者而言至关重要。然而，初步结果表明，LDLT 对于丙型肝炎病毒（HCV）阳性患者可能不利。
研究对象为 23 例因 HCV 肝硬化接受 LDLT 的患者。所有患者均接受了由干扰素 -α2b 和利巴韦林组成的抗病毒预处理，该治疗在术后约 1 个月开始。治疗在首次 HCV RNA 检测呈阴性后持续 12 个月。然后，患者在未接受治疗的情况下观察 6 个月（第 1 组）。即使 HCV RNA 检测仍为阳性，治疗也持续至少 12 个月（第 2 组）。如果患者因不良反应无法持续治疗 12 个月或因早期死亡无法开始治疗，则将其排除在研究方案之外。
8 例患者被排除在研究方案之外。9 例患者被分配到第 1 组，另外 6 例被分配到第 2 组。病毒学持续应答率为 39%（23 例中的 9 例）。治疗 1 年后，两组在组织学活性评分方面存在显著差异。HCV 阳性患者的 3 年累积生存率为 85%，与 HCV 阴性患者（n = 93 [90%]）相当。
目前 LDLT 后的预防性抗病毒方案是安全的，可能值得进行一项对照研究以证实其对移植物存活的益处。
