Faisal Nabiha, Bilodeau Marc, Aljudaibi Bandar, Hirch Geri, Yoshida Eric M, Hussaini Trana, Ghali Maged P, Congly Stephen E, Ma Mang M, Lilly Leslie B
From the Organ Transplant and Hepatobiliary Department, King Abdulaziz Medical City/National Guard Health Sciences, Riyadh, Saudi Arabia.
Exp Clin Transplant. 2019 Feb;17(1):59-63. doi: 10.6002/ect.2017.0201. Epub 2018 Apr 4.
We assessed the impact of sofosbuvir-based regimens on renal function in liver transplant recipients with recurrent hepatitis C virus and the role of renal function on the efficacy and safety of these regimens.
In an expanded pan-Canadian cohort, 180 liver transplant recipients were treated with sofosbuvir-based regimens for hepatitis C virus recurrence from January 2014 to May 2015. Mean age was 58 ± 6.85 years, and 50% had F3/4 fibrosis. Patients were stratified into 4 groups based on baseline estimated glomerular filtration rate (calculated by the Modification of Diet in Renal Disease formula): < 30, 30 to 45, 46 to 60, and > 60 mL/min/173 m2. The primary outcome was posttreatment changes in renal function from baseline. Secondary outcomes included sustained virologic response at 12 weeks posttreatment and anemia-related and serious adverse events.
Posttreatment renal function was improved in most patients (58%). Renal function declined in 22% of patients, which was more marked in those with estimated glomerular filtration rate < 30 mL/min/173 m2, advanced cirrhosis (P = .05), and aggressive hepatitis C virus/fibrosing cholestatic hepatitis (P < .05). High rates (80%-88%) of sustained virologic response at 12 weeks posttreatment were seen across all renal function strata. Cirrhotic patients with glomerular filtration rates < 30 mL/min/173 m2 had sustained virologic response rates at 12 weeks posttreatment comparable to the overall patient group. Rates of anemia-related adverse events and transfusion requirements increased across decreasing estimated glomerular filtration rate groups, with notably more occurrences with ribavirin-based regimens.
Sofosbuvir-based regimens improved overall renal function in liver transplant recipients, with sustained virologic response, suggesting an association of subclinical hepatitis C virus-related renal disease. Sustained virologic response rates at 12 weeks posttreatment (80%-88%) were comparable regardless of baseline renal function but lower in cirrhosis.
我们评估了基于索磷布韦的治疗方案对丙型肝炎病毒复发的肝移植受者肾功能的影响，以及肾功能对这些治疗方案疗效和安全性的作用。
在一个扩大的全加拿大队列中，从2014年1月至2015年5月，180例肝移植受者接受了基于索磷布韦的方案治疗丙型肝炎病毒复发。平均年龄为58±6.85岁，50%的患者有F3/4纤维化。根据基线估计肾小球滤过率（采用肾脏病饮食改良公式计算）将患者分为4组：<30、30至45、46至60和>60 mL/min/173 m²。主要结局是治疗后肾功能相对于基线的变化。次要结局包括治疗后12周的持续病毒学应答以及贫血相关和严重不良事件。
大多数患者（58%）治疗后的肾功能得到改善。22%的患者肾功能下降，在估计肾小球滤过率<30 mL/min/173 m²、晚期肝硬化（P = 0.05）以及侵袭性丙型肝炎病毒/纤维化胆汁淤积性肝炎患者中更为明显（P < 0.05）。在所有肾功能分层中，治疗后12周的持续病毒学应答率均较高（80%-88%）。肾小球滤过率<30 mL/min/173 m²的肝硬化患者治疗后12周的持续病毒学应答率与总体患者组相当。随着估计肾小球滤过率组的降低，贫血相关不良事件和输血需求的发生率增加，基于利巴韦林的方案中更为明显。
基于索磷布韦的方案改善了肝移植受者的总体肾功能，并具有持续病毒学应答，提示存在亚临床丙型肝炎病毒相关肾病。无论基线肾功能如何，治疗后12周的持续病毒学应答率相当（80%-88%），但在肝硬化患者中较低。
