Klinik für Allgemein-, Viszeral-, und Transplantationschirurgie, Charité Campus Virchow-Klinikum, Universitätsmedizin Berlin, Berlin, Germany.
Dig Dis Sci. 2010 Jul;55(7):2063-9. doi: 10.1007/s10620-009-0982-2. Epub 2009 Oct 2.
The recurrence of hepatitis C virus (HCV) after liver transplantation (OLT) leads to recurrent cirrhosis in up to 40% of patients.
To identify patients who profit the most from antiviral therapy and to delineate whether early treatment after OLT is effective to reach sustained virological response (SVR), we analyzed factors associated to SVR during pegylated interferon/ribavirin (PegIFN/RBV) therapy.
A retrospective analysis of efficiency and viral decline kinetics in 83 HCV-infected liver transplant recipients who received therapy with PegIFN/RBV was carried out.
Forty-one of 83 (49.4%) patients became HCV RNA-negative. SVR was achieved in 26/83 (31.3%) patients. Viral decline of at least 2 log 10 (n = 47) at week 12 was significantly associated with an end-of-treatment (EOT) response. Eleven early viral response patients were not able to clear HCV RNA, whereas five patients without a 2 log decline achieved SVR. The highest predictive value for SVR was an undetectable viremia at week 24 (92%).
The outcome of antiviral combination therapy for HCV reinfection after OLT can be best predicted by week-24 virologic response. The high SVR rates in patients with detectable HCV RNA at week 12 might suggest a prolonged treatment protocol in liver transplant recipients.
丙型肝炎病毒（HCV）在肝移植（OLT）后复发，导致多达 40%的患者复发肝硬化。
确定从抗病毒治疗中获益最多的患者，并确定 OLT 后早期治疗是否有效达到持续病毒学应答（SVR），我们分析了接受聚乙二醇干扰素/利巴韦林（PegIFN/RBV）治疗期间与 SVR 相关的因素。
对 83 例接受 PegIFN/RBV 治疗的 HCV 感染肝移植受者的疗效和病毒下降动力学进行回顾性分析。
83 例患者中有 41 例（49.4%）HCV RNA 转阴。83 例患者中有 26 例（31.3%）达到 SVR。在第 12 周时病毒下降至少 2 个对数 10（n = 47）与治疗结束时（EOT）反应显著相关。11 例早期病毒应答患者未能清除 HCV RNA，而 5 例无 2 个对数下降的患者达到 SVR。预测 SVR 的最高价值是第 24 周时不可检测的病毒血症（92%）。
OLT 后 HCV 再感染的抗病毒联合治疗的结果可以通过第 24 周的病毒学反应来最好地预测。在第 12 周时可检测到 HCV RNA 的患者具有较高的 SVR 率，这可能提示肝移植受者需要延长治疗方案。
