Department of Gastroenterology and Hepatology, Western University, London, Canada.
Saudi J Gastroenterol. 2013 Sep-Oct;19(5):223-9. doi: 10.4103/1319-3767.118133.
BACKGROUND/AIM: In patients with advanced post-transplant hepatitis C virus (HCV) recurrence, antiviral treatment (AVT) with interferon and ribavirin is indicated to prevent graft failure. The aim of this study was to determine and report Canadian data with respect to the safety, efficacy, and spontaneous virologic response (SVR) predictors of AVT among transplanted patients with HCV recurrence.
A retrospective chart review was performed on patients transplanted in London, Ontario and Edmonton, Alberta from 2002 to 2012 who were treated for HCV. Demographic, medical, and treatment information was collected and analyzed.
A total of 85 patients with HCV received pegylated interferon with ribavirin post-liver transplantation and 28 of the 65 patients (43%) with genotype 1 achieved SVR. Of the patients having genotype 1 HCV who achieved SVR, there was a significantly lower stage of fibrosis (1.37 ± 0.88 vs. 1.89 ± 0.96; P = 0.03), increased ribavirin dose (total daily dose 1057 ± 230 vs. 856 ± 399 mg; P = 0.02), increased rapid virologic response (RVR) (6/27 vs. 0/31; P = 0.05), increased early virologic response (EVR) (28/28 vs. 18/35; P = 0.006), and longer duration of therapy (54.7 ± 13.4 weeks vs. 40.2 ± 18.7; P = 0.001). A logistic regression model using gender, age, RVR, EVR, anemia, duration of therapy, viral load, years' post-transplant, and type of organ (donation after cardiac death vs. donation after brain death) significantly predicted SVR (P < 0.001), with duration of therapy having a significant odds ratio of 1.078 (P = 0.007).
This study identified factors that predict SVR in HCV-positive patients who received dual therapy post-transplantation. Extending therapy from 48 weeks to 72 weeks of dual therapy is associated with increased SVR rates. Future studies examining the role of extended therapy are needed to confirm these findings, since the current study is a retrospective one.
背景/目的：在患有晚期移植后丙型肝炎病毒（HCV）复发的患者中，使用干扰素和利巴韦林进行抗病毒治疗（AVT）可预防移植物失功。本研究的目的是确定并报告加拿大在移植后 HCV 复发患者中 AVT 的安全性、疗效和自发病毒学应答（SVR）预测因素的数据。
对 2002 年至 2012 年在安大略省伦敦和艾伯塔省埃德蒙顿接受 HCV 治疗的患者进行了回顾性图表审查。收集并分析了人口统计学、医学和治疗信息。
共有 85 例 HCV 患者在肝移植后接受了聚乙二醇干扰素联合利巴韦林治疗，65 例基因型 1 患者中有 28 例（43%）获得 SVR。在获得 SVR 的基因型 1 HCV 患者中，纤维化分期明显较低（1.37±0.88 与 1.89±0.96；P=0.03），利巴韦林剂量增加（总日剂量 1057±230 与 856±399 mg；P=0.02），快速病毒学应答（RVR）增加（6/27 与 0/31；P=0.05），早期病毒学应答（EVR）增加（28/28 与 18/35；P=0.006），治疗时间延长（54.7±13.4 周与 40.2±18.7 周；P=0.001）。使用性别、年龄、RVR、EVR、贫血、治疗持续时间、病毒载量、移植后年限和器官类型（心脏死亡后捐献与脑死亡后捐献）的逻辑回归模型显著预测 SVR（P<0.001），治疗持续时间的优势比具有显著意义（1.078，P=0.007）。
本研究确定了 HCV 阳性患者在移植后接受双重治疗时预测 SVR 的因素。将双重治疗的持续时间从 48 周延长至 72 周与 SVR 率的增加相关。需要进一步研究以证实这些发现，因为本研究是回顾性的。
