Sugawara Yasuhiko, Tamura Sumihito, Kokudo Norihiro
Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Hepat Res Treat. 2010;2010:475746. doi: 10.1155/2010/475746. Epub 2010 Nov 1.
A significant proportion of patients with chronic hepatitis C virus (HCV) infection develop liver cirrhosis and complications of end-stage liver disease over two to three decades and require liver transplantation, however, reinfection is common and leads to further adverse events under immunosuppression. Pretransplant antiviral or preemptive therapy is limited to mildly decompensated patients due to poor tolerance. The mainstay of management represents directed antiviral therapy after evidence of recurrence of chronic hepatitis C. Combined pegylated interferon and ribavirin therapy is the current standard treatment with sustained viral response rates of 25% to 45%. The rate is lower than that in the immunocompetent population, partly due to the high prevalence of intolerability. To date, there is no general consensus regarding the antiviral treatment modality, timing, or dosing for HCV in patients with advanced liver disease and after liver transplantation. New anti-HCV drugs to delay disease progression or to enhance viral clearance are necessary.
相当一部分慢性丙型肝炎病毒（HCV）感染者在二三十年内会发展为肝硬化和终末期肝病并发症，需要进行肝移植，然而，再感染很常见，并会在免疫抑制状态下导致进一步的不良事件。由于耐受性差，移植前抗病毒或抢先治疗仅限于轻度失代偿患者。管理的主要手段是在慢性丙型肝炎复发证据出现后进行直接抗病毒治疗。聚乙二醇化干扰素和利巴韦林联合治疗是目前的标准治疗方法，持续病毒应答率为25%至45%。该比率低于免疫功能正常人群，部分原因是不耐受的高发生率。迄今为止，对于晚期肝病患者和肝移植后HCV的抗病毒治疗方式、时机或剂量尚无普遍共识。需要新的抗HCV药物来延缓疾病进展或提高病毒清除率。
