Seifert Leon Louis, Heinzow Hauke, Kabar Iyad, Christensen Stefan, Hüsing Anna, Schmidt Hartmut H-J
Department of Transplantation Medicine, University Hospital Münster, Münster, Germany.
, Center for Interdisciplinary Medicine (CIM) Infectious Diseases, Münster, Germany.
Am J Case Rep. 2016 Aug 24;17:605-10. doi: 10.12659/ajcr.895839.
BACKGROUND Direct-acting antivirals (DAAs) represent a new hallmark in antiviral therapy of hepatitis C virus (HCV). DAAs have been shown to be safe and effective after liver transplantation (LT), but there is little information about their use in peritransplant settings. Former intravenous drug users represent an increasing group seeking HCV treatment. This case report demonstrates the successful peritransplant antiviral treatment of a former intravenous drug user who had been treated in a methadone maintenance program. CASE REPORT The patient was diagnosed with Child B cirrhosis for the first time in 2009. He had a Model for End-stage Liver Disease (MELD) score of 21 and started antiviral therapy with sofosbuvir (SOF) and daclatasvir (DCV) in March 2014. Due to hepatic decompensation, he received a LT in April 2014. Immunosuppression was performed with tacrolimus (TAC) and mycophenolate-mofetil (MMF), and boosted with prednisolone in the initial stage. Four weeks after his LT, the patient presented with an acute renal injury. The patient was discharged one week later after sufficient hydration, discontinuation of non-steroidal anti-phlogistics therapy, and adjustments to his immunosuppressive regimen. At the beginning of his therapy, the number of RNA copies was 13,000 IU/mL. He received 24 weeks of anti-HCV treatment with SOF and DCV; the antiviral treatment was successful and his LT was well tolerated. CONCLUSIONS Treatment of HCV is feasible in a peritransplant setting. The antiviral regimen we used did not seem to have any relevant interactions with the patient's immunosuppressive regimens. Still, the peritransplant setting is a very demanding environment for anti-HCV therapy, and further studies are needed.
背景 直接抗病毒药物（DAAs）代表了丙型肝炎病毒（HCV）抗病毒治疗的一个新里程碑。DAAs已被证明在肝移植（LT）后是安全有效的，但关于它们在移植前后阶段使用的信息很少。曾经的静脉吸毒者是寻求HCV治疗的人数不断增加的群体。本病例报告展示了一名曾在美沙酮维持治疗项目中接受治疗的曾经的静脉吸毒者在移植前后成功进行抗病毒治疗的情况。病例报告 该患者于2009年首次被诊断为Child B级肝硬化。他的终末期肝病模型（MELD）评分为21，并于2014年3月开始使用索磷布韦（SOF）和达卡他韦（DCV）进行抗病毒治疗。由于肝失代偿，他于2014年4月接受了肝移植。使用他克莫司（TAC）和霉酚酸酯（MMF）进行免疫抑制，并在初始阶段用泼尼松龙加强。肝移植四周后，患者出现急性肾损伤。在充分补液、停用非甾体抗炎治疗并调整免疫抑制方案后，患者一周后出院。治疗开始时，RNA拷贝数为13,000 IU/mL。他接受了24周的SOF和DCV抗HCV治疗；抗病毒治疗成功，他的肝移植耐受性良好。结论 HCV治疗在移植前后阶段是可行的。我们使用的抗病毒方案似乎与患者的免疫抑制方案没有任何相关相互作用。尽管如此，移植前后阶段对于抗HCV治疗来说是一个要求非常高的环境，还需要进一步研究。
