Anand Anil C, Agarwal Shaleen K, Garg Hitendra K, Khanna Sudeep, Gupta Subhash
Department of Hepatology & Gastroenterology, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, New Delhi 110076, India.
J Clin Exp Hepatol. 2017 Sep;7(3):165-171. doi: 10.1016/j.jceh.2017.06.007. Epub 2017 Jun 28.
Recurrent hepatitis C virus (HCV) has been a serious problem after liver transplantation (LT). We report our experience of 24-week therapy with sofosbuvir (SOF) and ribavirin (RBV) in post-LT recurrent HCV in living donor liver transplantation (LDLT) setting in South Asia.
Data from all patients treated for post-transplantation HCV recurrence in a single center were analyzed. Treatment regimen was 24 weeks of SOF 400 mg daily and RBV (starting at 800 mg daily, increased as tolerated). Sustained virological response (SVR) was assessed 12 weeks and 24 weeks after completion of treatment.
63 patients (median age 52 [range 30-69] years; 80% males) were treated. Most (76.2%) were treatment experienced and predominant HCV genotype was 3 (77.7%) followed by 1 (20.6%). Median transient elastography (Fibroscan) score was 7 (range 3-11) kPa and none of the patients had cirrhosis. SVR12 was achieved in 60 of 63 patients (95.2%) while SVR24 was noted in 59 (93.7%). SVR12 rates were as good in genotype-3 as in genotype-1. Older age, longer period after transplantation, higher Fibroscan value and higher need for erythropoietin were likely to be associated with relapse. Adverse effects were noted in 34 patients and weakness and fatigue were the commonest side effects. Significant drop in hemoglobin (<8 g/dL) was seen in 6 patients.
SOF + RBV combination therapy for 24 weeks was safe and effective in treatment of for post-LT recurrent HCV in a single LT center and remains relevant due to its low cost and lack of drug interactions.
丙型肝炎病毒（HCV）复发一直是肝移植（LT）后一个严重的问题。我们报告了在南亚活体肝移植（LDLT）环境下，使用索磷布韦（SOF）和利巴韦林（RBV）进行24周治疗复发性HCV的经验。
分析了在单一中心接受移植后HCV复发治疗的所有患者的数据。治疗方案为每日服用400毫克SOF和RBV（开始时每日800毫克，根据耐受情况增加剂量），疗程为24周。在治疗完成后12周和24周评估持续病毒学应答（SVR）。
共治疗了63例患者（中位年龄52岁[范围30 - 69岁]；80%为男性）。大多数患者（76.2%）有治疗史，主要的HCV基因型为3型（77.7%），其次是1型（20.6%）。瞬时弹性成像（Fibroscan）评分中位数为7（范围3 - 11）kPa，且所有患者均无肝硬化。63例患者中有60例（95.2%）实现了SVR12，59例（93.7%）实现了SVR24。SVR12率在3型基因型患者中与1型基因型患者中一样好。年龄较大、移植后时间较长、Fibroscan值较高以及对促红细胞生成素的需求较高可能与复发有关。34例患者出现了不良反应，虚弱和疲劳是最常见的副作用。6例患者血红蛋白显著下降（<8 g/dL）。
在单一肝移植中心，SOF + RBV联合治疗24周对于治疗肝移植后复发性HCV是安全有效的，并且由于其成本低和无药物相互作用，仍然具有重要意义。
