1 Department of Medicine, University of Pennsylvania, Philadelphia, PA.
Transplantation. 2015 Dec;99(12):2458-66. doi: 10.1097/TP.0000000000000847.
With a worldwide prevalence of 6% to 40% among patients with end-stage renal disease, hepatitis C virus (HCV) infection is a significant cause of comorbidity in kidney transplant candidates and recipients alike. Hepatitis C infection negatively impacts patient and allograft outcomes, predisposes to progressive liver disease and increases the risks of glomerular disease as well as new onset diabetes after transplantation. Treatment options until now have revolved around interferon, limited in efficacy, restricted to pretransplant administration because of concerns related to allograft dysfunction and immune stimulation, and fraught with high rates of intolerance. Direct-acting antivirals therapies are now emerging, providing the opportunity to effectively cure chronic HCV infection and to reduce the burden of hepatic and extrahepatic complications of HCV that are observed in kidney recipients, thereby offering hope of improved patient outcomes. Against a description of the major outcomes and risks that HCV+ kidney candidates and recipients encounter, and a summary of the pertinent studies of interferon-based therapies in this population, this review discusses the potential role for emerging direct-acting antivirals, proposing treatment algorithms that should be considered in the management of these complex patients. Conundrums relating to the new treatment, including the potential impact on the utilization of kidneys from HCV-infected donors, are presented.
在终末期肾病患者中，丙型肝炎病毒（HCV）感染的全球患病率为 6%至 40%，是导致肾移植候选者和受者合并症的重要原因。HCV 感染对患者和移植物均有不良影响，易导致进行性肝病，并增加肾小球疾病和移植后新发糖尿病的风险。直到现在，治疗方案一直围绕着干扰素展开，但干扰素疗效有限，由于担心移植物功能障碍和免疫刺激，只能在移植前使用，而且干扰素治疗不耐受的发生率很高。直接作用抗病毒药物治疗方案的出现为有效治疗慢性 HCV 感染提供了机会，也为减少肾移植受者中观察到的 HCV 相关肝内和肝外并发症的负担提供了机会，从而为改善患者预后带来了希望。本文在描述 HCV+肾移植候选者和受者所面临的主要结局和风险的基础上，对该人群中基于干扰素的治疗研究进行了总结，讨论了新兴直接作用抗病毒药物的潜在作用，并提出了在管理这些复杂患者时应考虑的治疗方案。文中还提出了与新疗法相关的难题，包括对 HCV 感染供体肾脏使用的潜在影响。
