Chen Tianyan, Terrault Norah A
Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA.
Curr Opin Organ Transplant. 2016 Apr;21(2):111-9. doi: 10.1097/MOT.0000000000000288.
This article reviews treatment options of the approved and soon-to-be approved direct-acting antiviral (DAA)-based therapies in the transplant setting.
DAA-based therapies have been shown to be effective and safe in achieving viral eradication in the majority of pre- and postliver transplant (LT) populations. Treatment decisions are guided by hepatitis C virus (HCV) genotype, the degree of renal dysfunction, and severity of cirrhosis. The addition of ribavirin is frequently needed to achieve highest viral eradication rates. Viral eradication pre-LT has been associated with fewer portal hypertensive complications and improved survival and effectively prevents recurrent HCV post-LT. For those with shorter time to LT, an alternative strategy is treatment with DAAs up to the time of LT to reduce the risk of post-LT recurrence. Therapies should be considered for all post-LT patients with recurrent HCV given the risk of accelerated disease progression. The sustained virological response rates among LT recipients parallel those of nontransplant patients.
With broader application of DAA therapy in the transplant setting, improved graft and patient survival and simplified post-LT management are likely. The availability of high potency DAA therapy with excellent safety profiles has transformed the HCV-infected LT population into a group that is no longer 'difficult-to-treat.'
本文综述了在移植环境中已获批和即将获批的基于直接作用抗病毒药物（DAA）疗法的治疗选择。
基于DAA的疗法已被证明在大多数肝移植前和肝移植后人群中实现病毒清除方面是有效且安全的。治疗决策受丙型肝炎病毒（HCV）基因型、肾功能不全程度和肝硬化严重程度的指导。通常需要加用利巴韦林以实现最高的病毒清除率。肝移植前的病毒清除与较少的门静脉高压并发症、改善的生存率相关，并有效预防肝移植后HCV复发。对于肝移植时间较短的患者，一种替代策略是在肝移植前使用DAA治疗以降低肝移植后复发的风险。鉴于疾病进展加速的风险，所有肝移植后复发HCV的患者均应考虑进行治疗。肝移植受者的持续病毒学应答率与非移植患者相当。
随着DAA疗法在移植环境中的更广泛应用，可能会改善移植物和患者的生存率，并简化肝移植后的管理。具有出色安全性的高效DAA疗法已将HCV感染的肝移植人群转变为不再“难以治疗”的群体。
