Campos-Varela Isabel, Agudelo Eliana Z, Sarkar Monika, Roberts John P, Terrault Norah A
Universidade de Santiago de Compostela (CLINURSID) and Department of Internal Medicine, Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
Department of Medicine, University of California-San Francisco, San Francisco, CA, USA.
Transpl Infect Dis. 2018 Feb;20(1). doi: 10.1111/tid.12809. Epub 2018 Jan 3.
The shortage of livers has led most transplant centers to use extended criteria donors. Hepatitis C virus (HCV) RNA-positive donor organs are typically not given to patients who have cleared HCV. A 64-year-old male with chronic hepatitis C, genotype 1b was listed for LT with hepatocellular carcinoma. While on the waiting list, the patient was treated with sofosbuvir, ledipasvir, and ribavirin and achieved an HCV RNA <15 IU/mL by week 10. At week 18 of a planned 24-week treatment course, the patient underwent deceased-donor LT and received an organ from an anti-HCV-positive donor. Treatment was stopped at LT. At week 3 post LT, HCV RNA was detectable and revealed a genotype 3 HCV infection, compatible with transplantation of an organ with established infection. With retreatment with sofosbuvir, daclatasvir, and ribavirin for 12 weeks, the patient achieved a sustained virologic response. This report highlights how antiviral therapies can be used to optimize the outcomes of HCV-infected transplant patients.
肝脏短缺已导致大多数移植中心使用扩大标准供体。丙型肝炎病毒（HCV）RNA阳性的供体器官通常不会给予已清除HCV的患者。一名64岁的慢性丙型肝炎男性，基因1b型，因肝细胞癌被列入肝移植名单。在等待名单期间，患者接受了索磷布韦、来迪帕司韦和利巴韦林治疗，到第10周时HCV RNA<15 IU/mL。在计划的24周治疗疗程的第18周，患者接受了脑死亡供体肝移植，并接受了一名抗HCV阳性供体的器官。肝移植时停止治疗。肝移植后第3周，可检测到HCV RNA，显示为基因3型HCV感染，与移植已感染器官相符。再次使用索磷布韦、达卡他韦和利巴韦林治疗12周后，患者实现了持续病毒学应答。本报告强调了抗病毒疗法如何可用于优化HCV感染移植患者的治疗结果。
