Aqel Bashar A, Vargas Hugo E
Liver Transplant Program, Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, Arizona, USA.
Curr Opin Organ Transplant. 2015 Jun;20(3):259-66. doi: 10.1097/MOT.0000000000000195.
Transplantation is the best treatment for many patients with end-stage organ failure. Hepatitis C infection is prevalent among solid organ candidates and recipients and continues to represent a major source of morbidity and mortality. Prior interferon (IFN)-based therapies have been associated with limited efficacy and high rates of adverse events. Furthermore, prior IFN-based regimens are associated with high rates of allograft rejection limiting their use post-transplant. This review will outline the limited experience with current treatment regimens and how to incorporate the new hepatitis C virus (HCV) treatment regimens.
The introduction of new direct-acting antiviral (DAA) agents against HCV has dramatically altered the landscape of treatment for HCV. Different all-oral regimens are currently available and are rapidly becoming the standard for treating patients with chronic hepatitis C. Excluding patients with liver disease or those who received liver transplant, those regimens have not been studied in patients awaiting solid organ transplant, or those transplanted.
The safety and efficacy of DAAs in patients awaiting liver transplant and liver transplant recipients provide us with some insight and guidance on how to use those all-oral IFN-free regimens to allow effective treatment for patients who received or are awaiting nonliver solid organ transplants.
对于许多终末期器官衰竭患者而言，移植是最佳治疗方法。丙型肝炎感染在实体器官候选者和接受者中普遍存在，并且仍然是发病和死亡的主要来源。既往基于干扰素（IFN）的治疗疗效有限且不良事件发生率高。此外，既往基于IFN的治疗方案与同种异体移植排斥的高发生率相关，限制了其在移植后的应用。本综述将概述当前治疗方案的有限经验以及如何纳入新的丙型肝炎病毒（HCV）治疗方案。
针对HCV的新型直接作用抗病毒（DAA）药物的引入极大地改变了HCV的治疗格局。目前有不同的全口服方案，并且正迅速成为治疗慢性丙型肝炎患者的标准方案。除了患有肝病的患者或接受肝移植的患者外，这些方案尚未在等待实体器官移植的患者或已接受移植的患者中进行研究。
DAA在等待肝移植的患者和肝移植受者中的安全性和有效性为我们提供了一些关于如何使用这些不含IFN的全口服方案以便对接受或等待非肝脏实体器官移植的患者进行有效治疗的见解和指导。
