直接作用抗病毒药物在活体肝移植后对 HCV 的 preemptive 治疗。
Pre-emptive Treatment of HCV after Living Donor Liver Transplantation with Direct-Acting Antiviral Agents.
机构信息
Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
Asan Institute for Life Sciences, Asan-Minnesota Institute for Innovating Transplantation, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea.
出版信息
J Gastrointest Surg. 2018 Aug;22(8):1334-1342. doi: 10.1007/s11605-018-3779-9. Epub 2018 Apr 20.
BACKGROUND
Hepatitis C virus (HCV) universally recurs after liver transplantation (LT). Although the introduction of direct-acting antiviral agents (DAAs) has revolutionized the treatment of HCV infection, no optimal treatment for HCV recurrence after LT has been developed.
METHODS
This study retrospectively evaluated the efficacy of DAAs as a pre-emptive treatment for recurrent HCV infection after living donor liver transplantation (LDLT). From January 2010 to December 2016, 70 patients received pegylated interferon (PegIFN) and 35 patients were treated with DAA-based regimens to treat recurrent HCV after LDLT. All antiviral treatments were pre-emptive.
RESULTS
Genotype 1b was the most common HCV type (61.9%). Twenty-two recipients in the DAA group were treated with ledipasvir/sofosbuvir, nine received daclatasvir plus asunaprevir, three received sofosbuvir, and one received sofosbuvir plus daclatasvir. All 35 patients (100%) in the DAA group achieved a sustained virologic response (SVR), a percentage significantly higher than that (71.4%) in the PegIFN group (p < 0.001). In the PegIFN group, the 1-, 3-, and 5-year graft survival rates were 85.7, 73.9, and 70.7%, respectively, whereas those in the DAA group were 100, 100, and 100%, respectively (p = 0.008).
CONCLUSION
DAA-based regimens are an effective treatment for HCV recurrence after LDLT, resulting in an improved SVR and better graft survival than PegIFN.
背景
丙型肝炎病毒（HCV）在肝移植（LT）后普遍复发。虽然直接作用抗病毒药物（DAAs）的引入彻底改变了 HCV 感染的治疗方法，但尚未开发出治疗 LT 后 HCV 复发的最佳方法。
方法
本研究回顾性评估了 DAA 作为活体供肝移植（LDLT）后复发性 HCV 感染的预防性治疗的疗效。从 2010 年 1 月至 2016 年 12 月，70 例患者接受聚乙二醇干扰素（PegIFN）治疗，35 例患者接受 DAA 为基础的方案治疗 LDLT 后复发性 HCV。所有抗病毒治疗均为预防性治疗。
结果
1b 型 HCV 是最常见的 HCV 类型（61.9%）。DAA 组的 22 例患者接受 ledipasvir/sofosbuvir 治疗，9 例接受 daclatasvir 加asunaprevir 治疗，3 例接受 sofosbuvir 治疗，1 例接受 sofosbuvir 加 daclatasvir 治疗。DAA 组的 35 例患者（100%）均获得持续病毒学应答（SVR），显著高于 PegIFN 组（71.4%）（p<0.001）。在 PegIFN 组中，1、3 和 5 年移植物存活率分别为 85.7%、73.9%和 70.7%，而 DAA 组分别为 100%、100%和 100%（p=0.008）。
结论
DAA 为基础的方案是 LDLT 后 HCV 复发的有效治疗方法，与 PegIFN 相比，SVR 改善，移植物存活率更高。
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