Kanizaj Tajana Filipec, Colić-Cvrlje Vesna, Mrzljak Anna, Ostojić Rajko
Acta Med Croatica. 2013 Oct;67(4):373-81.
Recurrent infection with HCV after liver transplantation (LT) is almost universal and is associated with substantial morbidity, mortality and graft loss. In contrast to immunocompetent individuals, HCV infection in immunosuppressed transplant recipients usually has an accelerated course. Acute hepatitis develops in approximately 75% of HCV recipients in the first six months following LT. Within the five years after LT, over 80% of HCV-infected liver transplant recipients develop histologic evidence of chronic allograft injury secondary to HCV, with up to 30% of cirrhosis. While the choice of calcineurin inhibitors has not clearly shown to affect the histologic HCV recurrence or the frequency of rejection in HCV-infected recipients, the cumulative exposure to corticosteroids is associated with increased mortality, higher levels of HCV viremia, and more severe histologic recurrence. Successful therapy has been shown to have a positive impact on both graft and patient survival. Combination therapy with interferon (pegylated and non-pegylated forms) plus ribavirin appears to provide maximum benefits. Drug therapy is usually administered for recurrent disease. No prophylactic therapy is available. Preemptive regimens offer no distinctive advantages over treatments for recurrent disease. Overall, treatment is poorly tolerated, with frequent need for dose reductions, especially due to cytopenias, and drug discontinuation in up to 50% of patients. Optimizing drug doses is important in maximizing sustained virologic response rates (SVR). The SVR achieved is between 33% and 42% in randomized studies treating patients with histologic recurrence. The potential factors that influence this low SVR rate are:1) genotype 1 virus; 2) high viral load; 3) prior nonresponding to therapy; 4) side effects of antiviral treatment; 5) use of growth factors; and 6) effect of immunosuppression. In post-transplant patients with recurrent HCV disease, combination peg alpha-2b or alpha-2a in standard dose and ribavirin (800-1200 mg either ab initio or as an increasing dose) regimen for 48 weeks was significantly better than no therapy but not than any other therapy.
肝移植（LT）后丙型肝炎病毒（HCV）复发几乎普遍存在，且与严重的发病率、死亡率和移植物丢失相关。与免疫功能正常的个体不同，免疫抑制的移植受者中的HCV感染通常病程加速。在肝移植后的头六个月内，约75%的HCV受者会发生急性肝炎。在肝移植后的五年内，超过80%的HCV感染肝移植受者出现HCV继发的慢性移植物损伤的组织学证据，其中高达30%发展为肝硬化。虽然钙调神经磷酸酶抑制剂的选择尚未明确显示会影响HCV感染受者的组织学复发或排斥频率，但皮质类固醇的累积暴露与死亡率增加、HCV病毒血症水平升高以及更严重的组织学复发相关。已证明成功的治疗对移植物和患者存活均有积极影响。干扰素（聚乙二醇化和非聚乙二醇化形式）联合利巴韦林的联合治疗似乎能提供最大益处。药物治疗通常用于复发性疾病。目前尚无预防性治疗方法。抢先治疗方案与复发性疾病的治疗相比没有明显优势。总体而言，治疗耐受性差，经常需要减少剂量，尤其是由于血细胞减少，高达50%的患者需要停药。优化药物剂量对于最大化持续病毒学应答率（SVR）很重要。在治疗组织学复发患者的随机研究中，实现的SVR在33%至42%之间。影响这种低SVR率的潜在因素有：1）1型基因型病毒；2）高病毒载量；3）先前对治疗无反应；4）抗病毒治疗的副作用；5）生长因子的使用；6）免疫抑制的影响。在移植后复发性HCV疾病患者中，标准剂量的聚乙二醇化α-2b或α-2a联合利巴韦林（初始剂量或递增剂量为800 - 1200 mg）治疗48周明显优于不治疗，但不比任何其他治疗更好。
