Coilly Audrey, Roche Bruno, Duclos-Vallée Jean-Charles, Samuel Didier
AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, F-94800, France.
Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, F-94800, France.
Liver Int. 2016 Jan;36 Suppl 1:34-42. doi: 10.1111/liv.13017.
Hepatitis C virus (HCV) infection is one of the main causes of end-stage liver disease and indications for liver transplantation (LT) worldwide. HCV infection always recurs on the graft in patients who undergo LT with detectable serum HCV RNA, leading to cirrhosis in 20-30% within 5 years after transplantation. Achieving a sustained virological response (SVR) greatly improves patient and graft survival. Recently, the efficacy of therapy has radically changed and improved based on new direct acting antiviral agents (DAAs) without pegylated-interferon (PEG-IFN) and/or ribavirin (RBV), leading to SVR rates of more than 90% in transplanted patients. The safety profile in this population is also good, with limited drug-drug interactions. However, there are very few data on patients on the waiting list. Even when the results of combined DAAs are good (>80%), SVR rates are lower than in patients without cirrhosis. This review reports recent available data on the treatment of HCV infection in the transplant setting and discusses new dilemmas and challenges.
丙型肝炎病毒（HCV）感染是全球终末期肝病的主要原因之一，也是肝移植（LT）的指征。在接受肝移植且血清HCV RNA可检测到的患者中，HCV感染总会在移植肝中复发，导致20%-30%的患者在移植后5年内发生肝硬化。实现持续病毒学应答（SVR）可显著提高患者和移植肝的存活率。最近，基于新型直接作用抗病毒药物（DAA），在不使用聚乙二醇干扰素（PEG-IFN）和/或利巴韦林（RBV）的情况下，治疗效果发生了根本性的改变和改善，移植患者的SVR率超过90%。该人群的安全性也良好，药物相互作用有限。然而，关于等待名单上患者的数据非常少。即使联合使用DAA的结果良好（>80%），SVR率也低于无肝硬化的患者。本综述报告了移植环境中HCV感染治疗的最新可用数据，并讨论了新的困境和挑战。
