Mak Siu-Ka, Sin Ho-Kwan, Lo Kin-Yee, Lo Man-Wai, Chan Shuk-Fan, Lo Kwok-Chi, Wong Yuk-Yi, Ho Lo-Yi, Wong Ping-Nam, Wong Andrew K M
Renal Unit, Department of Medicine and Geriatrics, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong SAR, China.
Clin Exp Nephrol. 2017 Oct;21(5):764-770. doi: 10.1007/s10157-016-1364-7. Epub 2017 Jan 12.
In addition to the observation of an increased viremia among patients with chronic hepatitis C virus (HCV) infection who undergo renal transplantation, fibrosis and necroinflammatory activity have been noted to worsen comparing pre- and post-renal transplantation liver biopsies in some of these patients. Apart from the reported reduced patient and allograft survival rates, post-transplant diabetes mellitus, de novo glomerulonephritis, and an increased overall risk of infection have been observed. However, antiviral therapy for HCV is generally considered contraindicated among patients with solid organ transplants, with the main worry being the risk of acute rejection in relation to the use of interferon. We reported the long-term outcome of four renal transplant patients with chronic HCV infection who received peginterferon-based therapy.
We collected the long-term follow-up data of four patients who completed the therapy with peginterferon in combination with ribavirin. Two of them had renal impairment at baseline.
With treatment, they had a significant improvement in terms of serum liver transaminase level, and two patients achieved the early virological response and the other two rapid virological response. All four patients achieved sustained virological response, with neither HCV flare up nor renal dysfunction during follow-up for a mean duration of 74.3 months after therapy.
These results suggest that sustained HCV virological response may be achieved without allograft dysfunction, in selected renal transplant patients using a peginterferon-based therapy.
除了观察到接受肾移植的慢性丙型肝炎病毒（HCV）感染患者病毒血症增加外，还注意到其中一些患者肾移植前后肝脏活检相比，纤维化和坏死性炎症活动有所恶化。除了报道的患者和移植物存活率降低外，还观察到移植后糖尿病、新发肾小球肾炎以及感染总体风险增加。然而，对于实体器官移植患者，HCV抗病毒治疗通常被认为是禁忌的，主要担忧是使用干扰素会有急性排斥反应的风险。我们报告了4例接受基于聚乙二醇干扰素治疗的慢性HCV感染肾移植患者的长期预后情况。
我们收集了4例完成聚乙二醇干扰素联合利巴韦林治疗患者的长期随访数据。其中2例患者基线时有肾功能损害。
经过治疗，他们的血清肝转氨酶水平有显著改善，2例患者实现了早期病毒学应答，另外2例实现了快速病毒学应答。所有4例患者均实现了持续病毒学应答，治疗后平均随访74.3个月期间，既无HCV复发也无肾功能障碍。
这些结果表明，在选定的肾移植患者中使用基于聚乙二醇干扰素的治疗，可能在不出现移植物功能障碍的情况下实现HCV持续病毒学应答。
