McCarty Thomas R, Lim Joseph K
a Department of Internal Medicine , Yale University School of Medicine , New Haven , CT , USA.
b Section of Digestive Diseases , Yale University School of Medicine , New Haven , CT , USA.
Expert Opin Pharmacother. 2017 Feb;18(2):165-174. doi: 10.1080/14656566.2016.1276564. Epub 2017 Jan 6.
Currently, hepatitis C virus (HCV) infection remains the most common indication for liver transplant in the United States (US) with almost universal HCV recurrence in the post-liver transplant setting. Previous interferon (IFN)-related efficacy and tolerability concerns about worsening liver function have limited treatment options for many patients with HCV-associated decompensated liver disease and post-liver transplant recipients. However, the last decade has seen a seen a radical shift in the management of HCV with multiple direct-acting antiviral (DAA) treatments that provide more effective, all-oral, IFN-free alternatives. Areas covered: This review will serve to highlight the various pharmacotherapies available to clinicians for patients with HCV recurrence post-liver transplant. A brief history of prior regimens is provided with evidence for newer treatments presented. Also detailed are updated guidelines from societal organizations. Finally, timing of HCV treatment is discussed as the decision to treat patients in a pre or post-liver transplant setting remains challenging. Expert opinion: While there are many potential available therapies for HCV recurrence in the post-liver transplant setting, daclatasvir/sofosbuvir and ledipasvir/sofosbuvir have been the most extensively studied. Newer, pangenotypic generation drugs require more evidence before routine utilization in post-liver transplant recipients.
目前，丙型肝炎病毒（HCV）感染仍是美国肝移植最常见的指征，肝移植后几乎普遍会出现HCV复发。以往因担心干扰素（IFN）相关疗效及耐受性会使肝功能恶化，导致许多丙型肝炎病毒相关性失代偿性肝病患者和肝移植后受者的治疗选择受限。然而，在过去十年中，丙型肝炎的治疗发生了根本性转变，出现了多种直接抗病毒药物（DAA）治疗方案，这些方案提供了更有效、全口服、无干扰素的替代选择。涵盖领域：本综述旨在突出临床医生可用于肝移植后HCV复发患者的各种药物治疗方法。文中介绍了既往治疗方案的简要历史，并给出了新治疗方法的证据。还详细介绍了社会机构的最新指南。最后，讨论了HCV治疗的时机，因为决定在肝移植前还是肝移植后治疗患者仍然具有挑战性。专家观点：虽然对于肝移植后HCV复发有许多潜在的可用治疗方法，但达卡他韦/索磷布韦和来迪帕司韦/索磷布韦是研究最为广泛的。新型泛基因型药物在肝移植后受者中常规使用前需要更多证据。
