Herzer Kerstin, Gerken Guido
Kerstin Herzer, Guido Gerken, Department of Gastroenterology and Hepatology, University Hospital Essen, 45122 Essen, Germany.
World J Hepatol. 2015 Mar 27;7(3):532-8. doi: 10.4254/wjh.v7.i3.532.
The first interferon-free regimens have been approved for the treatment of patients with chronic hepatitis C virus (HCV). In the liver transplant (LT) setting, these regimens are expected to have an important effect, because graft loss due to HCV recurrence is a serious problem after LT. The response to the hitherto conventional treatment with pegylated interferon and ribavirin is poor. The significantly better response rates achieved with boceprevir-based and telaprevir-based triple therapy have led to better graft and patient survival rates, but severe drug interactions with immunosuppressants limit the feasibility of this therapy for LT patients. With the approval of sofosbuvir in January 2014, of simeprevir in May 2014, and of daclatasvir in August 2014, three antiviral agents are now available and promise to be applicable without relevant adverse effects or negative interactions with immunosuppressants. Thus, 2014 marks the beginning of a new era of treatment options for HCV recurrence after LT. Although safety and efficacy studies of several interferon-free regimens for patients with HCV recurrence after LT have achieved good preliminary results, reports of clinical experiences with LT patients are scarce. The lack of randomized studies, the small number of enrolled and carefully selected patients, and the heterogeneity of these studies make the results questionable. Real-life experiences are eagerly awaited so that clinicians can estimate the usefulness and the pitfalls of these new regimens. Additionally, the high costs of these agents may limit their accessibility for many patients. The aim of this review is to summarize the current experience with and the expectations of the new direct-acting antiviral agents for LT patients.
首款不含干扰素的治疗方案已获批用于治疗慢性丙型肝炎病毒（HCV）患者。在肝移植（LT）领域，这些方案有望产生重要影响，因为LT后因HCV复发导致的移植物丢失是一个严重问题。此前使用聚乙二醇化干扰素和利巴韦林的传统治疗效果不佳。基于博赛匹韦和基于特拉匹韦的三联疗法取得了显著更高的应答率，从而带来了更好的移植物和患者生存率，但与免疫抑制剂的严重药物相互作用限制了该疗法在LT患者中的可行性。随着索磷布韦于2014年1月获批、simeprevir于2014年5月获批以及达卡他韦于2014年8月获批，现在有三种抗病毒药物可供使用，有望在无相关不良反应或与免疫抑制剂无负面相互作用的情况下应用。因此，2014年标志着LT后HCV复发治疗选择新时代的开始。尽管针对LT后HCV复发患者的几种不含干扰素方案的安全性和疗效研究已取得良好的初步结果，但关于LT患者临床经验的报道却很少。缺乏随机研究、入组和精心挑选的患者数量少以及这些研究的异质性使得结果存在疑问。人们急切期待实际应用经验，以便临床医生能够评估这些新方案的实用性和潜在问题。此外，这些药物的高昂成本可能会限制许多患者的可及性。本综述的目的是总结LT患者使用新型直接抗病毒药物的当前经验和期望。
