Zanaga L P, Vigani A G, Angerami R N, Giorgetti A, Escanhoela C A F, Ataíde E C, Boin I F S F, Stucchi R S B
Disciplina de Infectologia, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil.
Departamento de Anatomia Patológica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil.
Braz J Med Biol Res. 2017 Jan 9;50(1):e5540. doi: 10.1590/1414-431X20165540.
Recurrent hepatitis C after orthotopic liver transplantation (OLT) is universal and can lead to graft failure and, consequently, reduced survival. Hepatitis C treatment can be used to prevent these detrimental outcomes. The aim of this study was to describe rates of hepatitis C recurrence and sustained virological response (SVR) to interferon-based treatment after OLT and its relationship to survival and progression of liver disease through retrospective analysis of medical records of 127 patients who underwent OLT due to cirrhosis or hepatocellular carcinoma secondary to chronic hepatitis C between January 2002 and December 2013. Fifty-six patients were diagnosed with recurrent disease, 42 started interferon-based therapy and 37 completed treatment. Demographic, treatment- and outcome-related variables were compared between SVR and non-responders (non-SVR). There was an overall 54.1% SVR rate with interferon-based therapies. SVR was associated with longer follow-up after treatment (median 66.5 vs 37 months for non-SVR, P=0.03) and after OLT (median 105 vs 72 months, P=0.074), and lower rates of disease progression (15 vs 64.7%, P=0.0028) and death (5 vs 35.3%, P=0.033). Regardless of the result of therapy (SVR or non-SVR), there was a significant difference between treated and untreated patients regarding the occurrence of death (P<0.001) and months of survival (P<0.001). Even with suboptimal interferon-based therapies (compared to the new direct-acting antivirals) there is a 54.1% SVR rate to treatment. SVR is associated with improved survival and reduced risks of clinical decompensation, loss of the liver graft and death.
原位肝移植（OLT）后丙型肝炎复发普遍存在，可导致移植肝衰竭，进而降低生存率。丙型肝炎治疗可用于预防这些不良后果。本研究的目的是通过回顾性分析2002年1月至2013年12月间因慢性丙型肝炎继发肝硬化或肝细胞癌而接受OLT的127例患者的病历，描述OLT后丙型肝炎复发率和基于干扰素治疗的持续病毒学应答（SVR）及其与生存率和肝病进展的关系。56例患者被诊断为疾病复发，42例开始基于干扰素的治疗，37例完成治疗。比较了SVR者和无应答者（非SVR）之间的人口统计学、治疗及结局相关变量。基于干扰素的治疗总体SVR率为54.1%。SVR与治疗后更长的随访时间（非SVR者中位数为66.5个月，SVR者为37个月，P = 0.03）和OLT后更长的随访时间（中位数分别为105个月和72个月，P = 0.074）相关，且疾病进展率（分别为15%和64.7%，P = 0.0028）和死亡率（分别为5%和35.3%，P = 0.033）更低。无论治疗结果如何（SVR或非SVR），治疗组和未治疗组在死亡发生率（P < 0.001）和生存月数（P < 0.001）方面存在显著差异。即使使用次优的基于干扰素的治疗（与新型直接抗病毒药物相比），治疗的SVR率仍为54.1%。SVR与生存率提高及临床失代偿、肝移植丢失和死亡风险降低相关。
