Multi-organ Transplant Program, University Health Network, University of Toronto, Toronto, ON, Canada.
Transplantation. 2009 Nov 27;88(10):1214-21. doi: 10.1097/TP.0b013e3181bd783c.
Efficacy and long-term outcome of antiviral therapy for recurrent hepatitis C after liver transplantation is poorly defined.
This study aimed at assessing the efficacy of antiviral therapy regarding sustained hepatitis C virus (HCV) clearance, liver histology, and patient survival.
We retrospectively reviewed all 446 patients who received a liver allograft at our institution for HCV-related cirrhosis between January 1992 and December 2006. Two hundred thirty-two patients (52%) were eligible for antiviral therapy based on predefined criteria (Metavir stage > or =1 and/or grade > or =2; protocol biopsies). One hundred seventy-two patients (39%) had no contraindication for treatment, received more than or equal to 1 dose of interferon-alpha-based combination therapy, and form the basis of this analysis. Therapy was aimed for 48 weeks; median posttreatment follow-up was 68 months.
The overall sustained virological response (SVR) rate was 50% (genotype 1/4: 40%; genotype 2/3: 76%). SVR was higher on cyclosporine A (CsA) (56%) than on tacrolimus (44%, P=0.05), largely because of a lower relapse rate (6% vs. 19%, P=0.01). In multivariate analysis, genotype 2/3, CsA use, donor age, and pretreatment necroinflammatory activity were independently associated with SVR. SVR significantly improved histology and long-term survival (actuarial 5-year survival 96% vs. 69% in nonresponders, P<0.0001).
Antiviral therapy of recurrent hepatitis C after liver transplantation is able to clear HCV in half the patients, more likely on CsA than on tacrolimus, and markedly improves outcome.
肝移植后复发丙型肝炎的抗病毒治疗效果和长期预后仍不清楚。
本研究旨在评估抗病毒治疗对持续清除丙型肝炎病毒（HCV）、肝组织学和患者生存的疗效。
我们回顾性分析了 1992 年 1 月至 2006 年 12 月期间在我院接受肝移植的 446 例丙型肝炎相关肝硬化患者。根据预先确定的标准（Metavir 分期>或=1 级和/或分级>或=2 级；方案活检），232 例患者（52%）适合抗病毒治疗。172 例患者（39%）无治疗禁忌证，接受了至少 1 剂干扰素-α联合治疗，是本分析的基础。治疗目标为 48 周；中位治疗后随访时间为 68 个月。
总体持续病毒学应答（SVR）率为 50%（基因型 1/4：40%；基因型 2/3：76%）。环孢素 A（CsA）组（56%）的 SVR 高于他克莫司（Tac）组（44%，P=0.05），主要是因为复发率较低（6%对 19%，P=0.01）。多变量分析显示，基因型 2/3、CsA 应用、供者年龄和治疗前坏死性炎症活动与 SVR 独立相关。SVR 显著改善了组织学和长期生存（无应答者的 5 年生存率分别为 96%和 69%，P<0.0001）。
肝移植后复发丙型肝炎的抗病毒治疗能够清除 HCV，CsA 优于 Tac，且明显改善预后。
