Hanif Farina Muhammad, Laeeq S Mudassir, Mandhwani Rajesh Kumar, Luck Nasir Hassan, Aziz Tahir, Mehdi Syed Haider
Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
Exp Clin Transplant. 2017 Feb;15(Suppl 1):63-67. doi: 10.6002/ect.mesot2016.O50.
Although direct-acting antiviral agents have revolutionized hepatitis C virus treatment, these novel agents are not widely available in the developing world. Further, no treatment recommendation for renal transplant recipients includes these agents. We aimed to evaluate the effectiveness of sofosbuvir and ribavirin, the only direct-acting antiviral agents available in Pakistan, in renal transplant recipients.
All renal transplant recipients receiving sofosbuvir and ribavirin from August 2015 to March 2016 were enrolled in the study. Patients' demographics and baseline laboratory parameters were collected. Rapid virologic response, early virologic response, end-of-treatment response, and sustained virologic response at 12 and 24 weeks were analyzed. Statistical analyses were performed using IBM SPSS Statistics software, version 20.0.
Of the 37 renal transplant recipients, the mean age was 37.2 ± 10.7 years and the majority (33 [89.2% ]) were men. Twenty-five patients were treatment naive; of the remaining 12 patients, 10 were responders, 2 were nonresponders, and 5 were relapsers to pretransplant hepatitis C treatment. The genotype most commonly seen posttransplant was genotype 1 (56.8%). Rapid virologic response was achieved in 33 patients (89.2%). Early virologic response, end-oftreatment response, and sustained virologic response at 12 weeks were achieved in all 37 patients (100%). Until the time of data collection, 14 patients had achieved a sustained virologic response at 24 weeks. No complications were noted during therapy. In 2 of 4 patients who developed decompensated cirrhosis, treatment led to the resolution of ascites.
Sofosbuvir and ribavirin are well tolerated and effective in renal transplant recipients for eradicating hepatitis C virus. Their effectiveness is not limited to renal transplant recipients with genotypes 1, 2, 3, and 4 but also extends to those with mixed genotype (in this study, genotypes 1 and 3).
尽管直接作用抗病毒药物彻底改变了丙型肝炎病毒的治疗方式，但这些新型药物在发展中国家并未广泛可得。此外，针对肾移植受者的治疗推荐中并未包含这些药物。我们旨在评估巴基斯坦唯一可用的直接作用抗病毒药物索磷布韦和利巴韦林在肾移植受者中的疗效。
纳入2015年8月至2016年3月期间所有接受索磷布韦和利巴韦林治疗的肾移植受者。收集患者的人口统计学资料和基线实验室参数。分析快速病毒学应答、早期病毒学应答、治疗结束时应答以及12周和24周时的持续病毒学应答。使用IBM SPSS Statistics软件20.0版进行统计分析。
37例肾移植受者的平均年龄为37.2±10.7岁，大多数（33例[89.2%]）为男性。25例患者既往未接受过治疗；其余12例患者中，10例为应答者，2例为无应答者，5例为移植前丙型肝炎治疗的复发者。移植后最常见的基因型为1型（56.8%）。33例患者（89.2%）实现了快速病毒学应答。37例患者（100%）均实现了早期病毒学应答、治疗结束时应答以及12周时的持续病毒学应答。截至数据收集时，14例患者在24周时实现了持续病毒学应答。治疗期间未观察到并发症。在4例发生失代偿性肝硬化的患者中，有2例治疗后腹水消退。
索磷布韦和利巴韦林在肾移植受者中耐受性良好且对根除丙型肝炎病毒有效。它们的疗效不仅限于基因型1、2、3和4的肾移植受者，还扩展至混合基因型（本研究中为基因型1和3）的患者。
