Olivera-Martínez Marco Antonio, Gallegos-Orozco Juan F
Department of Organ Transplantation, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Arch Med Res. 2007 Aug;38(6):691-701. doi: 10.1016/j.arcmed.2006.09.003.
Hepatitis C represents more than 35% of liver transplant candidates worldwide. Meanwhile, hepatitis B continues to be an important cause of end-stage liver disease and hepatocellular carcinoma in Asia and Africa. Recurrent viral liver disease is a significant event after liver transplantation and continues to be one of the main causes of graft dysfunction and loss in the middle and long-term follow-up. Mechanisms of liver reinfection and disease recurrence vary between these two viruses and pre-emptive as well as the therapeutic approaches are different. Hepatitis B patients can be managed with immune globulin immediately after liver transplant and various agents such as nucleotide and nucleoside analogues can be associated. As a result, disease recurrence has been delayed or prevented in these patients. Individuals transplanted for hepatitis C are known to have universal reinfection and a high rate of disease recurrence has been reported in the literature. Strategies to treat hepatitis C recurrence are limited to the use of pegylated interferon and ribavirin when disease is demonstrated histologically and biochemically, although other strategies have been described with limited or no success. We herein review the mechanisms of disease recurrence and the current as well as the future therapeutic approaches to prevent and to treat these diseases.
丙型肝炎在全球范围内占肝移植候选者的比例超过35%。与此同时，乙型肝炎仍是亚洲和非洲终末期肝病及肝细胞癌的重要病因。复发性病毒性肝病是肝移植后的一个重大事件，并且在中长期随访中仍然是移植物功能障碍和丧失的主要原因之一。这两种病毒导致肝脏再次感染和疾病复发的机制不同，预防和治疗方法也有所不同。乙型肝炎患者在肝移植后可立即使用免疫球蛋白进行治疗，还可联合使用各种药物，如核苷酸和核苷类似物。因此，这些患者的疾病复发已得到延缓或预防。已知丙型肝炎患者移植后会普遍再次感染，文献报道其疾病复发率很高。丙型肝炎复发的治疗策略仅限于在组织学和生化检查证实疾病时使用聚乙二醇化干扰素和利巴韦林，尽管也描述了其他策略，但效果有限或未取得成功。我们在此综述疾病复发的机制以及预防和治疗这些疾病的当前及未来治疗方法。
