Fabrizi Fabrizio, Lunghi Giovanna, Ganeshan Sri Venkatesh, Martin Paul, Messa Piergiorgio
Division of Nephrology, Maggiore Hospital, IRCCS, Milan, Italy.
Semin Dial. 2007 Sep-Oct;20(5):416-22. doi: 10.1111/j.1525-139X.2007.00311.x.
Hepatitis C virus (HCV) remains common in patients undergoing regular dialysis and is an important cause of liver disease in this population both during dialysis and after renal transplantation (RT). Anti-HCV screening of blood products has almost eliminated posttransfusion HCV infection but acquisition of HCV continues to occur in dialysis patients because of nosocomial spread. The natural history of HCV in dialysis population is not completely understood though recent data show that HCV infection has a detrimental role on survival of chronic dialysis patients. Several clinical trials have suggested that the response rate to conventional interferon (IFN) is higher in dialysis patients than those with normal kidney function but tolerance is lower. There are only limited data about pegylated IFN alone or in association with ribavirin for hepatitis C in dialysis population. IFN remains contraindicated post-RT because of concern about precipitating graft dysfunction; however, preliminary evidence shows the durability of sustained response to antiviral therapy pre-RT after renal transplant. Successful pretransplant therapy is associated with several benefits after RT including reduced incidence of posttransplant diabetes mellitus and de novo glomerulonephritis in HCV-infected recipients.
丙型肝炎病毒（HCV）在接受定期透析的患者中仍然很常见，并且是该人群在透析期间和肾移植（RT）后肝病的重要原因。对血液制品进行抗HCV筛查几乎消除了输血后HCV感染，但由于医院内传播，透析患者中仍不断出现HCV感染。尽管最近的数据表明HCV感染对慢性透析患者的生存有不利影响，但透析人群中HCV的自然史尚未完全了解。几项临床试验表明，透析患者对传统干扰素（IFN）的反应率高于肾功能正常的患者，但耐受性较低。关于聚乙二醇化干扰素单独或与利巴韦林联合用于透析人群丙型肝炎的资料有限。由于担心引发移植功能障碍，RT后IFN仍然是禁忌；然而，初步证据表明肾移植前抗病毒治疗的持续反应具有持久性。移植前成功的治疗与RT后的几个益处相关，包括降低HCV感染受者移植后糖尿病和新发肾小球肾炎的发生率。
