Kawaoka Tomokazu, Takahashi Shoichi, Kawakami Yoshiiku, Tsuge Masataka, Hiramatsu Akira, Imamura Michio, Hyogo Hideyuki, Aikata Hiroshi, Ishiyama Kohei, Tashiro Hirotaka, Ohdan Hideki, Tanaka Junko, Chayama Kazuaki
Department of Gastroenterology and Metabolism, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan.
Department of Surgery, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Science, Hiroshima University, Hiroshima, Japan.
Hepatol Res. 2015 Nov;45(11):1047-54. doi: 10.1111/hepr.12447. Epub 2014 Dec 2.
Previous European and North American studies analyzed the relationship between survival rate and sustained virological response (SVR) to interferon (IFN) therapy in patients with recurrent hepatitis C viral (HCV) infection after liver transplantation (LT). The present study was designed to define the same relationship in Japanese patients who had undergone LT.
Forty-seven patients (genotype 1, 40; genotype 2, 7) with recurrent HCV after LT were treated with pegylated interferon (PEG IFN) or IFN/ribavirin (RBV). In possible, within 3 months after LT, patients started treatment with PEG IFN-α-2b or IFN-α-2b s.c. once weekly combined with RBV (200 mg/day).
The SVR rate was 51% (24/47) for all patients, 42.5% (17/40) for genotype 1 and 100% (7/7) for genotype 2. The median follow-up period was 71 months (range, 24-152). The survival rate of 24 patients who achieved SVR was 95% at 5 years and 92% at 10 years. These rates were significantly better than those of 23 patients who did not achieve SVR (82% at 5 years, 58% at 10 years) (P = 0.027). Two patients of the SVR group died during follow up (due to hepatocellular carcinoma in one and chronic rejection in one), while six non-SVR patients died during the same period (three died due to liver failure by recurrent HCV).
SVR following IFN therapy contributes to improvement of survival rate in patients with recurrent post-LT HCV infection.
以往欧洲和北美的研究分析了肝移植（LT）后复发性丙型肝炎病毒（HCV）感染患者的生存率与干扰素（IFN）治疗的持续病毒学应答（SVR）之间的关系。本研究旨在明确日本LT患者中的这种关系。
47例LT后复发性HCV患者（基因1型40例，基因2型7例）接受聚乙二醇干扰素（PEG IFN）或IFN/利巴韦林（RBV）治疗。可能的话，在LT后3个月内，患者开始接受PEG IFN-α-2b或IFN-α-2b皮下注射，每周1次，联合RBV（200mg/天）。
所有患者的SVR率为51%（24/47），基因1型为42.5%（17/40），基因2型为100%（7/7）。中位随访期为71个月（范围24 - 152个月）。24例实现SVR的患者5年生存率为95%，10年生存率为92%。这些比率显著优于23例未实现SVR的患者（5年生存率82%，10年生存率58%）（P = 0.027）。SVR组有2例患者在随访期间死亡（1例死于肝细胞癌，1例死于慢性排斥反应），而同期有6例非SVR患者死亡（3例死于复发性HCV导致的肝衰竭）。
IFN治疗后的SVR有助于提高LT后复发性HCV感染患者的生存率。
