Lin Ta-Ya, Yeh Ming-Lun, Huang Ching-I, Chen Yao-Li, Dai Chia-Yen, Huang Jee-Fu, Lin Zu-Yau, Chen Shinn-Cherng, Huang Chung-Feng, Yu Ming-Lung, Chuang Wan-Long
Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Medical University, Kaohsiung, Taiwan.
Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Medical University, Kaohsiung, Taiwan; Faculty of Internal Medicine, School of Medicine, College of Medicine, and Center for Lipid and Glycomedicine Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
Kaohsiung J Med Sci. 2017 Jun;33(6):284-289. doi: 10.1016/j.kjms.2017.03.007. Epub 2017 Apr 20.
Posttransplant hepatitis C virus (HCV) recurrence is universal in chronic hepatitis C recipients. Antiviral therapy is suggested after liver transplant to halt disease progression. Pegylated interferon plus ribavirin therapy remains the standard of care in many areas where direct antiviral agents are poorly accessible. This study aimed to assess the treatment efficacy and safety of the regimen for Taiwanese patients with post-transplant HCV recurrence. Nine patients with HCV recurrence postliver transplantation were allocated. Patients received either pegylated interferon α-2a 180 μg/wk or pegylated interferon α-2b 1.5 mg/kg/wk plus ribavirin for 24-48 weeks. The primary endpoint was the achievement of sustained virological response (SVR), defined as undetectable HCV RNA throughout 6 months of follow-up after the end of treatment. The safety profiles were also documented. The rates of rapid virological response, early virological response, end-of-treatment virological response, and SVR were 33%, 63%, 75%, and 56% respectively. Of the four patients who failed antiviral treatment, the treatment responses were nonresponse (n = 1), loss of follow-up (n = 1), and relapse (n = 2). Three patients terminated therapy early due to severe adverse events, including severe anemia, intra-abdomen infection, and hepatocellular carcinoma recurrence. One of the three patients who terminated treatment early at Week 6 experienced rapid virological response followed by SVR. Pegylated interferon/ribavirin combination allowed a chance for cure with a fair SVR rate in Taiwanese chronic hepatitis C patients postliver transplantation. Early identification of side effects and careful monitoring during therapy might enhance the treatment efficacy.
肝移植后丙型肝炎病毒（HCV）复发在慢性丙型肝炎受体中普遍存在。肝移植后建议进行抗病毒治疗以阻止疾病进展。在许多难以获得直接抗病毒药物的地区，聚乙二醇化干扰素联合利巴韦林治疗仍是标准治疗方案。本研究旨在评估该方案对台湾肝移植后HCV复发患者的治疗疗效和安全性。纳入9例肝移植后HCV复发患者。患者接受聚乙二醇化干扰素α-2a 180μg/周或聚乙二醇化干扰素α-2b 1.5mg/kg/周加利巴韦林治疗24 - 48周。主要终点是获得持续病毒学应答（SVR），定义为治疗结束后6个月随访期间HCV RNA检测不到。同时记录安全性情况。快速病毒学应答、早期病毒学应答、治疗结束时病毒学应答和SVR的发生率分别为33%、63%、75%和56%。在4例抗病毒治疗失败的患者中，治疗反应为无应答（n = 1）、失访（n = 1）和复发（n = 2）。3例患者因严重不良事件提前终止治疗，包括严重贫血、腹腔内感染和肝细胞癌复发。在第6周提前终止治疗的3例患者中，有1例经历了快速病毒学应答，随后获得SVR。聚乙二醇化干扰素/利巴韦林联合治疗为台湾肝移植后慢性丙型肝炎患者提供了治愈机会，SVR率尚可。早期识别副作用并在治疗期间仔细监测可能会提高治疗效果。
