Carrión José A, Navasa Miquel, García-Retortillo Montserrat, García-Pagan Juan Carlos, Crespo Gonzalo, Bruguera Miquel, Bosch Jaime, Forns Xavier
Liver Unit, Institut de Malalties Digestives, Hospital Clinic, Ciberehd and IDIBAPS, University of Barcelona, Barcelona, Spain.
Gastroenterology. 2007 May;132(5):1746-56. doi: 10.1053/j.gastro.2007.03.041. Epub 2007 Mar 24.
BACKGROUND & AIMS: Recurrence of hepatitis C virus (HCV) infection is a relevant problem of liver transplantation programs. We evaluated the effect of antiviral therapy on disease progression in 81 HCV-infected liver transplantation recipients.
Patients with mild hepatitis C recurrence (fibrosis stage F0 to F2, n = 54) were randomized to no treatment (group A, n = 27) or peginterferon alfa-2b/ribavirin for 48 weeks (group B, n = 27). Patients with severe recurrence (F3 to F4, cholestatic hepatitis) were treated (group C, n = 27). All patients (n = 81) underwent a liver biopsy at baseline and after follow-up; paired hepatic venous pressure gradient (HVPG) measurements were available in 51 patients.
Thirteen (48%) patients of group B and 5 (18.5%) of group C achieved sustained virological response. Liver fibrosis progressed > or =1 stage in 40 (49%) of 81 patients: 19 (70%) of group A versus 7 (26%) of group B (P = .001) and in 14 (54%) of group C. HVPG increased (6.5 to 13 mm Hg, P < .01) in patients in whom fibrosis worsened, whereas it decreased (5 to 3.5 mm Hg, P = .017) or remained unchanged in those with fibrosis improvement or stabilization, respectively. The only variable independently associated with fibrosis improvement/stabilization was treatment (odds ratio [OR] =3.7, 95% confidence interval [CI] 1.3 to 10, P = .009). Among treated patients, alanine aminotransferase (ALT) normalization and viral clearance were independently associated with histological or hemodynamic improvement/stabilization (OR 5.3, 95% CI 1.5 to 18, P < .01; OR 7.4, 95% CI 1.4 to 38, P = .01; respectively).
Our data demonstrate that in liver transplantation recipients, antiviral therapy slows disease progression (particularly in sustained virological responders), as shown by its effects on liver histology and on HVPG.
丙型肝炎病毒（HCV）感染复发是肝移植项目中的一个相关问题。我们评估了抗病毒治疗对81例HCV感染肝移植受者疾病进展的影响。
轻度丙型肝炎复发患者（纤维化分期F0至F2，n = 54）被随机分为不治疗组（A组，n = 27）或接受聚乙二醇干扰素α-2b/利巴韦林治疗48周（B组，n = 27）。重度复发患者（F3至F4，胆汁淤积性肝炎）接受治疗（C组，n = 27）。所有患者（n = 81）在基线和随访后均接受肝活检；51例患者可进行配对肝静脉压力梯度（HVPG）测量。
B组13例（48%）患者和C组5例（18.5%）患者实现了持续病毒学应答。81例患者中有40例（49%）肝纤维化进展≥1期：A组19例（70%），B组7例（26%）（P = 0.001），C组14例（54%）。纤维化恶化的患者HVPG升高（6.5至13 mmHg，P < 0.01），而纤维化改善或稳定的患者HVPG分别降低（5至3.5 mmHg，P = 0.017）或保持不变。与纤维化改善/稳定独立相关的唯一变量是治疗（优势比[OR] = 3.7，95%置信区间[CI] 1.3至10，P = 0.009）。在接受治疗的患者中，丙氨酸氨基转移酶（ALT）正常化和病毒清除与组织学或血流动力学改善/稳定独立相关（分别为OR 5.3，95% CI 1.5至18，P < 0.01；OR 7.4，95% CI 1.4至38，P = 0.01）。
我们的数据表明，在肝移植受者中，抗病毒治疗可减缓疾病进展（特别是在持续病毒学应答者中），这在其对肝脏组织学和HVPG的影响中得到体现。
