Du Ling-Yao, Tang Hong
Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Hepat Mon. 2011 Nov;11(11):880-6. doi: 10.5812/kowsar.1735143X.712. Epub 2011 Nov 30.
Patients with end-stage renal disease can easily acquire a hepatitis C virus (HCV) infection via several ways. An HCV infection is difficult to treat after renal transplantation due to the conflicting actions of immunosuppressant therapy to maintain the function of the transplanted kidney and viricidal interferon (IFN) or ribavirin (RBV) treatment. Antiviral therapy requires great caution to avoid the complex and potentially fatal pharmacological effects. In this review, we examined clinical challenges and potential solutions for this specific scenario.
We searched Pubmed (NLM), LISTA (EBSCO), Web of Science (TS). The management of patients on waiting list, the indications and regimens about treatment were studied.
More than forty papers about this topic were found, including seven small clinical trials. International consensus has been reached to test patients awaiting renal transplantation. HCV detection after renal transplantation warrants careful consideration of when to initiate antiviral therapy. Treatment will begin immediately if deteriorating liver function increases the risk for loss of renal function. The choice of regimen depends on the patient's renal function and is individualized under close observation. The immunosuppressive regimen will be adjusted accordingly before antiviral therapy is initiated.
The effects of modified antiviral therapy on these patients varies because of individual characteristics and disease state, and also because of the difficulty associated with conducting a large clinical trial to obtain statistically sound conclusions. The management before transplantation is important and when antiviral therapy needs to start, careful consideration of risks and benefits is needed before initiating this type of treatment.
终末期肾病患者可通过多种途径轻易感染丙型肝炎病毒（HCV）。肾移植后，由于免疫抑制治疗对维持移植肾功能的作用与抗病毒干扰素（IFN）或利巴韦林（RBV）治疗存在冲突，HCV感染难以治疗。抗病毒治疗需要格外谨慎，以避免复杂且可能致命的药理作用。在本综述中，我们研究了针对这一特定情况的临床挑战和潜在解决方案。
我们检索了PubMed（美国国立医学图书馆）、LISTA（EBSCO）、科学网（汤森路透）。研究了等待名单上患者的管理、治疗指征和方案。
发现了四十多篇关于该主题的论文，包括七项小型临床试验。已达成国际共识，对等待肾移植的患者进行检测。肾移植后HCV检测需要仔细考虑何时开始抗病毒治疗。如果肝功能恶化增加了肾功能丧失的风险，将立即开始治疗。治疗方案的选择取决于患者的肾功能，并在密切观察下个体化制定。在开始抗病毒治疗前，免疫抑制方案将相应调整。
改良抗病毒治疗对这些患者的效果因个体特征和疾病状态而异，也因开展大型临床试验以获得统计学上可靠结论的难度而异。移植前的管理很重要，且在需要开始抗病毒治疗时，在启动此类治疗前需要仔细权衡风险和益处。
