Akin Mete, Buldukoglu Osman Cagin, Adanir Haydar, Suleymanlar Inci, Dincer Dinc, Yildirim Bulent
Department of Gastroenterology, Akdeniz University Faculty of Medicine, Antalya, Turkey.
SAGE Open Med. 2018 Jun 5;6:2050312118781416. doi: 10.1177/2050312118781416. eCollection 2018.
Successful treatment is possible with novel direct-acting oral antiviral agents in solid organ transplant patients with hepatitis C. In this study, the effectiveness and safety of sofosbuvir/ledipasvir ± ribavirin treatment in liver and/or renal transplant patients with chronic hepatitis C were evaluated.
A total of 23 liver and/or renal transplant patients who received sofosbuvir/ledipasvir ± ribavirin for chronic hepatitis C over 12 or 24 weeks were enrolled in the study. The treatment response, clinical and laboratory adverse effects, and effect on immunosuppressive drug levels were assessed.
A total of 12 patients had undergone renal transplantation and 11 had undergone liver transplantation. All of the renal transplant patients and 91% of liver transplant patients had genotype 1. In total, 10 renal transplant patients and 4 liver transplant patients had treatment experience. Two renal transplant patients and one liver transplant patient had compensated cirrhosis. Nine renal transplant patients were on tacrolimus, and two were on cyclosporine; all of the liver transplant patients were on tacrolimus-based immunosuppressive therapy. While hepatitis C RNA was negative in 75% of renal transplant patients and 91% of liver transplant patients at week 4, it was negative in all of the patients at the end of treatment and 12 weeks after treatment. Significantly reduced hemoglobin levels were observed in patients administered ribavirin during treatment (p = 0.01). There were no significant differences between the baseline and treatment period values of mean creatinine, estimated glomerular filtration rate, bilirubin, and tacrolimus levels. There were no adverse effects leading to treatment discontinuation.
Sofosbuvir/ledipasvir ± ribavirin is quite safe and effective in hepatitis C treatment after liver and/or renal transplantation.
对于接受实体器官移植的丙型肝炎患者，使用新型直接作用口服抗病毒药物进行成功治疗是可行的。在本研究中，评估了索磷布韦/维帕他韦±利巴韦林治疗肝和/或肾移植慢性丙型肝炎患者的有效性和安全性。
共有23例接受索磷布韦/维帕他韦±利巴韦林治疗12周或24周的肝和/或肾移植慢性丙型肝炎患者纳入本研究。评估治疗反应、临床和实验室不良反应以及对免疫抑制药物水平的影响。
共有12例患者接受了肾移植，11例接受了肝移植。所有肾移植患者和91%的肝移植患者为基因1型。共有10例肾移植患者和4例肝移植患者有治疗经验。2例肾移植患者和1例肝移植患者有代偿性肝硬化。9例肾移植患者使用他克莫司，2例使用环孢素；所有肝移植患者均接受基于他克莫司的免疫抑制治疗。在第4周时，75%的肾移植患者和91%的肝移植患者丙型肝炎病毒RNA呈阴性，在治疗结束时和治疗后12周所有患者均呈阴性。治疗期间接受利巴韦林治疗的患者血红蛋白水平显著降低（p = 0.01）。平均肌酐、估计肾小球滤过率、胆红素和他克莫司水平的基线值与治疗期值之间无显著差异。没有导致治疗中断的不良反应。
索磷布韦/维帕他韦±利巴韦林在肝和/或肾移植后丙型肝炎治疗中相当安全有效。
