丙型肝炎活体肝移植后治疗干扰素诱导的移植物功能障碍的策略。

Strategies to treat interferon-induced graft dysfunction after living donor liver transplantation for hepatitis C.

作者信息

Ikegami Toru, Wang Huanlin, Yoshizumi Tomoharu, Toshima Takeo, Aishima Shinichi, Fukuhara Takasuke, Furusyo Norihiro, Kotoh Kazuhiro, Shimoda Shinji, Shirabe Ken, Maehara Yoshihiko

机构信息

Department of Surgery and Science, Graduate School of Medical Science, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.

Department of Anatomic Pathology, Graduate School of Medical Science, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.

出版信息

Hepatol Int. 2014 Apr;8(2):285-92. doi: 10.1007/s12072-013-9496-2. Epub 2013 Dec 27.

DOI:10.1007/s12072-013-9496-2

PMID:26202510

Abstract

PURPOSE

Interferon-induced graft dysfunction (IGD) is a poorly defined, unrecognized, but potentially serious condition for patients receiving antiviral drugs after liver transplantation for hepatitis C.

METHODS

We evaluated the characteristics of 80 patients who received pegylated interferon-based antiviral treatment for hepatitis C after living donor liver transplantation (LDLT).

RESULTS

Eight patients experienced IGD either during (n = 6) or after completing (n = 2) antiviral treatment. Pathological diagnosis included acute cellular rejection (ACR, n = 1), plasma cell hepatitis (PCH, n = 2), PCH plus ACR (n = 3), and chronic rejection (CR, n = 2). One patient with CR initially presented with PCH plus ACR and the other presented with ACR; both had apparent cholestasis. The six patients with ACR or PCH without cholestasis were successfully treated by discontinuing antiviral treatment and increasing immunosuppression, including steroids. By contrast, both of the patients with CR and cholestasis experienced graft loss, despite aggressive treatment. Univariate analysis showed that pegylated interferon-α2a-based treatment (75 vs. 26.4 %, p < 0.01) was the only significant factor for IGD, and was associated with decreased 5-year graft survival (93.4 vs. 71.4 %, p = 0.04).

CONCLUSIONS

IGD is a serious condition during or even after antiviral treatment for hepatitis C after LDLT. Early recognition, diagnosis, discontinuation of interferon, and introduction of steroid-based treatment may help to save the graft.

摘要

目的

干扰素诱导的移植物功能障碍（IGD）是一种定义不明确、未被认识但对丙型肝炎肝移植后接受抗病毒药物治疗的患者可能具有严重影响的病症。

方法

我们评估了80例在活体肝移植（LDLT）后接受聚乙二醇干扰素为基础的丙型肝炎抗病毒治疗患者的特征。

结果

8例患者在抗病毒治疗期间（n = 6）或完成治疗后（n = 2）发生IGD。病理诊断包括急性细胞排斥反应（ACR，n = 1）、浆细胞性肝炎（PCH，n = 2）、PCH合并ACR（n = 3）和慢性排斥反应（CR，n = 2）。1例CR患者最初表现为PCH合并ACR，另1例表现为ACR；两者均有明显胆汁淤积。6例无胆汁淤积的ACR或PCH患者通过停用抗病毒治疗和增加免疫抑制（包括使用类固醇）成功治愈。相比之下，2例有CR和胆汁淤积的患者尽管接受了积极治疗仍发生移植物丢失。单因素分析显示基于聚乙二醇干扰素-α2a的治疗（75%对26.4%，p < 0.01）是IGD的唯一显著因素，且与5年移植物存活率降低相关（93.4%对71.4%，p = 0.04）。