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两例接受聚乙二醇干扰素/利巴韦林/替拉瑞韦三联治疗的肝移植后复发丙型肝炎患者。

Two patients treated with pegylated interferon/ribavirin/telaprevir triple therapy for recurrent hepatitis C after living donor liver transplantation.

机构信息

Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.

出版信息

Hepatol Res. 2014 Nov;44(12):1259-64. doi: 10.1111/hepr.12296. Epub 2014 Feb 17.

Abstract

It is difficult to use protease inhibitors in patients with recurrent hepatitis C virus (HCV) infection after liver transplantation (LT) due to interaction with immunosuppressive drugs. We report our experience with two patients treated with telaprevir (TVR) combined with pegylated interferon/ribavirin (PEG IFN/RBV) for recurrent HCV genotype 1 infection after LT. The first was a 63-year-old man with HCV-related liver cirrhosis, who failed to respond to IFN-β plus RBV after LT. Treatment was switched to PEG IFN-α-2b plus RBV and TVR was started. The donor had TT genotype of interleukin (IL)-28 single nucleotide polymorphisms (SNP) (rs8099917). The recipient had TT genotype of IL-28 SNP (rs8099917). Completion of 12-week triple therapy was followed by PEG IFN-α-2b plus RBV for 36 weeks. Finally, he had sustained viral response. The second was a 70-year-old woman with HCV-related liver cirrhosis and hepatocellular carcinoma. She failed to respond to PEG IFN-α-2b plus RBV after LT, and was subsequently switched to PEG IFN-α-2b/RBV/TVR. Genotype analysis showed TG genotype of IL-28 SNP for the donor, and TT genotype of IL-28 SNP for the recipient. Serum HCV RNA titer decreased below the detection limit at 5 weeks. However, triple therapy was withdrawn at 11 weeks due to general fatigue, which resulted in HCV RNA rebound 4 weeks later. Both patients were treated with cyclosporin, starting with a small dose to avoid interactions with TVR. TVR is a potentially suitable agent for LT recipients who do not respond to PEG IFN-α-2b plus RBV after LT.

摘要

由于与免疫抑制剂药物的相互作用,肝移植(LT)后复发丙型肝炎病毒(HCV)感染的患者很难使用蛋白酶抑制剂。我们报告了两名接受特拉匹韦(TVR)联合聚乙二醇干扰素/利巴韦林(PEG IFN/RBV)治疗 LT 后复发 HCV 基因型 1 感染的患者的经验。第一个是一名 63 岁的男性,因 HCV 相关肝硬化在 LT 后未能对 IFN-β加 RBV 产生反应。治疗方案改为 PEG IFN-α-2b 加 RBV,并开始 TVR 治疗。供体具有白细胞介素(IL)-28 单核苷酸多态性(SNP)(rs8099917)的 TT 基因型。受者具有 IL-28 SNP(rs8099917)的 TT 基因型。完成 12 周三联疗法后,继续接受 PEG IFN-α-2b 加 RBV 治疗 36 周。最终,他获得了持续病毒学应答。第二个是一名 70 岁的女性,因 HCV 相关肝硬化和肝细胞癌在 LT 后未能对 PEG IFN-α-2b 加 RBV 产生反应,随后改为 PEG IFN-α-2b/RBV/TVR。基因型分析显示供体的 IL-28 SNP 为 TG 基因型,受者的 IL-28 SNP 为 TT 基因型。血清 HCV RNA 滴度在 5 周时降至检测限以下。然而,由于全身疲劳,三联疗法在 11 周时被停用,导致 4 周后 HCV RNA 反弹。两名患者均开始使用小剂量环孢素治疗,以避免与 TVR 发生相互作用。TVR 是 LT 受者的一种潜在合适药物,LT 受者在 LT 后对 PEG IFN-α-2b 加 RBV 无反应。

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