Carbone Marco, Lenci Ilaria, Baiocchi Leonardo
Marco Carbone, Liver Unit, Queen Elizabeth Hospital, Birmingham, B15 2TH, United Kingdom.
World J Gastrointest Pharmacol Ther. 2012 Aug 6;3(4):36-48. doi: 10.4292/wjgpt.v3.i4.36.
Hepatitis C related liver failure and hepatocarcinoma are the most common indications for liver transplantation in Western countries. Recurrent hepatitis C infection of the allograft is universal and immediate following liver transplantation, being associated with accelerated progression to cirrhosis, graft loss and death. Graft and patient survival is reduced in liver transplant recipients with recurrent Hepatitis C virus (HCV) infection compared to HCV-negative recipients. Many variables may impact on recurrent HCV liver disease. Overall, excess immunosuppression is believed to be a key factor; however, no immunosuppressive regimen has been identified to be more beneficial or less harmful. Donor age limitations, exclusion of moderately to severely steatotic livers and minimization of ischemic times could be a potential strategy to minimize the severity of HCV disease in transplanted subjects. After transplantation, antiviral therapy based on pegylated IFN alpha with or without ribavirin is associated with far less results than that reported for immunocompetent HCV-infected patients. New findings in the field of immunotherapy and genomic medicine applied to this context are promising.
丙型肝炎相关的肝衰竭和肝癌是西方国家肝移植最常见的适应证。肝移植后，同种异体移植物立即普遍发生丙型肝炎病毒复发感染，这与肝硬化进展加速、移植物丢失和死亡相关。与丙型肝炎病毒阴性的受者相比，丙型肝炎病毒（HCV）复发感染的肝移植受者的移植物和患者生存率降低。许多变量可能影响复发性丙型肝炎肝病。总体而言，免疫抑制过度被认为是一个关键因素；然而，尚未确定哪种免疫抑制方案更有益或危害更小。限制供体年龄、排除中度至重度脂肪变性肝脏以及尽量缩短缺血时间可能是将移植受者丙型肝炎疾病严重程度降至最低的潜在策略。移植后，基于聚乙二醇化干扰素α联合或不联合利巴韦林的抗病毒治疗效果远低于免疫功能正常的丙型肝炎病毒感染患者。应用于这一背景下的免疫治疗和基因组医学领域的新发现很有前景。
