Department of Infection and Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; Division of Neurology, University Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
Department of Infection and Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; Institute of Hepatology, Wenzhou Medical University, Wenzhou 325000, China.
Gene. 2014 Jul 10;544(2):101-6. doi: 10.1016/j.gene.2014.04.072. Epub 2014 May 1.
Hepatitis C virus (HCV) infection is the major cause of chronic liver disease after renal transplantation (RT), which reduces both graft and patient survival. After RT, the most widely used approach is interferon (IFN)-based therapy of hepatitis C which may be unsatisfactory with both poor efficacy and an increasing risk of allograft rejection. Thus, it is not recommended unless patients develop fibrosing cholestatic hepatitis. Several recent studies, however, suggest that treatment was possible with preservation of both renal and liver functions. From the limited studies on HCV infection after RT, several factors have been identified as important tools for the management of therapy in these patients. Infection with HCV genotypes 2 and 3, low baseline viral load and absence of advanced fibrosis/cirrhosis in the liver are associated with a sustained virologic response (SVR). After initiation of treatment, initial viral decline with undetectable HCV-RNA at week 4 of therapy (RVR) is the best predictor of SVR independent of HCV genotype. Furthermore, some factors must be taken into consideration in order to avoid allograft rejection, such as the time between transplantation and therapy for HCV, the dose and duration of regimen and renal function. Careful evaluation of predictions of stable renal function and SVR for those patients helps to reduce inefficient treatment regimes and to increase the cure rate in addition to reducing the possible risk. In this review, the latest information was collected and we focus on the discussion of the factors influencing the attainment of SVR after RT.
丙型肝炎病毒（HCV）感染是肾移植（RT）后慢性肝病的主要原因，它降低了移植物和患者的存活率。在 RT 后，最广泛使用的方法是基于干扰素（IFN）的丙型肝炎治疗，其疗效不佳且移植排斥的风险增加。因此，除非患者发生纤维性胆汁性肝炎，否则不建议使用。然而，最近的几项研究表明，在保留肾和肝功能的情况下，可以进行治疗。从有限的 RT 后 HCV 感染研究中，已经确定了几个因素，这些因素是这些患者治疗管理的重要工具。感染 HCV 基因型 2 和 3、低基线病毒载量和肝脏无晚期纤维化/肝硬化与持续病毒学应答（SVR）相关。在开始治疗后，治疗第 4 周时 HCV-RNA 不可检测的初始病毒下降（RVR）是独立于 HCV 基因型预测 SVR 的最佳指标。此外，为了避免移植物排斥，必须考虑一些因素，如 HCV 治疗与移植之间的时间、方案的剂量和持续时间以及肾功能。仔细评估那些患者的稳定肾功能和 SVR 的预测有助于减少低效的治疗方案，并增加治愈率，同时降低可能的风险。在这篇综述中，我们收集了最新的信息，重点讨论了影响 RT 后 SVR 获得的因素。
