Pillai A A, Lee V S, Wang E, Rinella M E, Levitsky J
Department of Transplant Surgery and Hepatology, Northwestern Memorial Hospital, and Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
Transplant Proc. 2010 Nov;42(9):3647-51. doi: 10.1016/j.transproceed.2010.06.018.
Antiviral therapy has achieved sustained virological response (SVR) in less than one third of orthotopic liver transplantation (OLT) patients with recurrent hepatitis C.
The aim of this study was to identify predictors of SVR in OLT patients treated with pegylated interferon and ribavirin (PEG+RBV) for recurrent hepatitis C virus (HCV).
We analyzed data from our transplantation database for 62 subjects treated with PEG+RBV between August 2001 and September 2008. After univariate examination for factors known to be associated with SVR, significant associations (P < .05) were probed using multivariate logistic regression. Kaplan-Meier patient and graft survival analyses were compared between patients with (n = 19; 30.6%) versus without SVR.
On univariate analysis, longer duration of therapy, low pretreatment HCV RNA (<1 million IU/mL), and early virological response (EVR) were associated with SVR. On multivariate analysis, only low pretreatment HCV RNA predicted SVR. Patient survival was significantly higher in the SVR group.
Covariates associated with SVR among OLT patients with recurrent HCV were similar to the pretransplantation group. Potentially modifiable risk factors, such as obesity, diabetes mellitus, and metabolic syndrome, were not significant predictors of treatment response. Patient survival was associated with SVR, highlighting the impact of successful HCV therapy on long-term post-OLT outcomes.
在接受原位肝移植（OLT）的复发性丙型肝炎患者中，抗病毒治疗实现持续病毒学应答（SVR）的患者不到三分之一。
本研究旨在确定接受聚乙二醇干扰素和利巴韦林（PEG+RBV）治疗复发性丙型肝炎病毒（HCV）的OLT患者实现SVR的预测因素。
我们分析了2001年8月至2008年9月间接受PEG+RBV治疗的62例患者的移植数据库数据。在对已知与SVR相关的因素进行单因素检查后，使用多因素逻辑回归分析显著相关性（P<.05）。对实现SVR的患者（n=19；30.6%）和未实现SVR的患者进行Kaplan-Meier患者和移植物生存分析比较。
单因素分析显示，治疗时间较长、治疗前HCV RNA水平较低（<100万IU/mL）和早期病毒学应答（EVR）与SVR相关。多因素分析显示，只有治疗前HCV RNA水平较低可预测SVR。SVR组患者生存率显著更高。
OLT复发性HCV患者中与SVR相关的协变量与移植前组相似。肥胖、糖尿病和代谢综合征等潜在可改变的危险因素不是治疗反应的显著预测因素。患者生存率与SVR相关，突出了成功的HCV治疗对OLT术后长期结局的影响。
