Artificial Organ and Transplantation Division, University of Tokyo, Tokyo, Japan.
Transpl Int. 2010 Jun;23(6):580-8. doi: 10.1111/j.1432-2277.2009.01023.x. Epub 2009 Dec 15.
Reports of large series in living donor liver transplantation (LDLT) for hepatitis C virus infection (HCV) are scarce. Between 1996 and 2008, 105 LDLTs were performed at the University of Tokyo for HCV. Rapid induction of antiviral treatment with interferon (IFN) and ribavirin (RBV) was attempted per protocol regardless of the clinical presentation of recurrent HCV (pre-emptive treatment approach). Treatment was continued for 12 months after serum HCV-RNA became negative (ETR: end-of-treatment response) and judged as a sustained viral response (SVR) after another 6 months of negative results without treatment. A fixed treatment period was not defined unless an ETR was achieved (no-stopping approach). Flexible dose adjustments were allowed. Ninety-five patients were eligible for pre-emptive therapy. Forty-three (45%) patients experienced an ETR, and 32 (34%) achieved SVR. Nonadherence to full-dose INF and RBV had little impact on the viral response. Evaluation using the Kaplan-Meier method to incorporate the cumulative time-dependent nature of the no-stopping approach estimated SVR rate at 53% by the fifth year. Survival rate at 5 years was 79% for the HCV recipients and did not differ significantly from our non-HCV series. In LDLT for HCV, pre-emptive IFN-RBV-based treatment with the application of no-stopping approach is feasible and effective.
在活体肝移植（LDLT）治疗丙型肝炎病毒（HCV）感染的大系列报道中较为少见。1996 年至 2008 年，东京大学共进行了 105 例 LDLT 治疗 HCV。根据方案，无论 HCV 复发的临床表现如何（抢先治疗方法），均尝试快速诱导抗病毒治疗，采用干扰素（IFN）和利巴韦林（RBV）。在血清 HCV-RNA 转阴后（治疗结束时反应（ETR）），治疗持续 12 个月，并且在无治疗的情况下连续 6 个月阴性结果后判断为持续病毒学应答（SVR）。除非达到 ETR（不停药方法），否则未定义固定治疗期。允许灵活剂量调整。95 例患者符合抢先治疗条件。43 例（45%）患者达到 ETR，32 例（34%）获得 SVR。不遵守全剂量 INF 和 RBV 对病毒反应影响不大。采用 Kaplan-Meier 方法评估不停药方法的累积时间依赖性，估计第 5 年时 SVR 率为 53%。HCV 受体的 5 年生存率为 79%，与我们的非 HCV 系列无显著差异。在 LDLT 治疗 HCV 中，采用不停药方法的 IFN-RBV 抢先治疗是可行且有效的。
