Barsa Jonathan E, Branch Andrea D, Schiano Thomas D
Mount Sinai Hospital of Queens, Astoria, NY, USA.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Clin Transplant. 2015 Oct;29(10):859-65. doi: 10.1111/ctr.12596. Epub 2015 Aug 29.
New and relatively well-tolerated medications to treat hepatitis C virus (HCV) infection have presented an opportunity for hepatologists to eliminate HCV in liver transplant (LT) candidates prior to transplantation. While concern for causing decompensated liver disease in the sickest subset of pre-transplant patients makes some clinicians reluctant to offer treatment, we believe that several advantages of early HCV eradication appear to shift the debate in favor of using anti-HCV agents before LT. There are encouraging safety data for new HCV medications in cirrhotic patients, and given the limited supply of donor livers available, delaying or possibly preventing the need for LT by treating HCV can offer significant benefit. Post-LT, making immunosuppression management easier as well as avoiding both extrahepatic manifestations of HCV (e.g., diabetes mellitus and kidney disease) and the dilemma of distinguishing post-transplant viral recurrence from allograft rejection makes earlier treatment of HCV especially appealing to clinicians. Furthermore, retrospective data have demonstrated a mortality benefit among HCV patients who are free of the virus at the time of LT. This article explores arguments for and against treating HCV in patients on the transplant list.
用于治疗丙型肝炎病毒（HCV）感染的新型且耐受性相对良好的药物，为肝病专家在肝移植（LT）候选者移植前清除HCV提供了契机。虽然担心在移植前病情最严重的患者亚组中引发失代偿性肝病，使得一些临床医生不愿提供治疗，但我们认为，早期根除HCV的若干优势似乎使争论转向支持在LT前使用抗HCV药物。对于肝硬化患者使用新型HCV药物，有令人鼓舞的安全性数据，而且鉴于可用供肝供应有限，通过治疗HCV来延迟或可能避免LT需求可带来显著益处。LT后，使免疫抑制管理更容易，同时避免HCV的肝外表现（如糖尿病和肾病）以及区分移植后病毒复发与移植排斥反应的困境，使得早期治疗HCV对临床医生尤其有吸引力。此外，回顾性数据表明，LT时无病毒的HCV患者有死亡率获益。本文探讨了支持和反对治疗移植名单上HCV患者的观点。
