在肝移植后基因型1b复发性丙型肝炎患者中，直接抗病毒药物的实际应用实现了100%的持续病毒学应答和纤维化改善。

100% sustained virological response and fibrosis improvement in real-life use of direct acting antivirals in genotype-1b recurrent hepatitis C following liver transplantation.

作者信息

Iacob Speranta, Cerban Razvan, Pietrareanu Corina, Ester Carmen, Iacob Razvan, Gheorghe Cristian, Popescu Irinel, Gheorghe Liana

机构信息

Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute; Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.

出版信息

J Gastrointestin Liver Dis. 2018 Jun;27(2):139-144. doi: 10.15403/jgld.2014.1121.272.100.

DOI:10.15403/jgld.2014.1121.272.100

PMID:29922758

Abstract

BACKGROUND

Nowadays, interferon-free therapy using new direct-acting antivirals (DAA) has dramatically increased the cure rate across different HCV-infected patient populations, including groups traditionally viewed as difficult-to-treat (patients with co-infections, cirrhosis and liver transplant - LT recipients) with marked improvement in safety and tolerability.

AIM

To present our experience with DAA therapy in LT recipients, as well as to compare pre- and post-treatment liver stiffness (LS) and noninvasive fibrosis scores.

METHODS

Our cohort consisted of 89 patients with genotype 1 (GT1) recurrent hepatitis C after LT. Seventy six patients received ombitasvir/paritaprevir/ritonavir+dasabuvir+ribavirin and 13 sofosbuvir/ledipasvir+/-ribavirin. Fibroscan®, FIB4 and APRI scores were performed in all patients before and 12 weeks after DAA therapy.

RESULTS

We analyzed 45 (50.5%) males and 44 (49.5%) females with a mean age of 55+/-7.7 years. Median time since LT was 20.9 months. At baseline, 53 (59.6%) of patients had severe necroinflammation at Fibromax®; advanced fibrosis (F3, F4) was encountered in 35 (39.4%) and grade 3 steatosis in 33 (37.1%) of LT recipients. End of therapy (EOT) virological response (VR) was 100%. Sustained virological response 12 weeks after therapy (SVR12) was 97.7% in the intention-to-treat analysis and 100% in per protocol analysis. There was a significant improvement in LS between antiviral therapy initiation and SVR12: 11.9+/-1.05kPa vs 8.8+/-0.6kPa (p<0.0001), as well as in APRI (2.7+/-0.3 vs 0.4+/-0.05, p<0.0001) and FIB4 (4.6+/-0.5 vs 2.5+/-0.2, p<0.0001) scores.

CONCLUSIONS

In HCV positive recipients, DAA regimens are highly effective and safe. A significant decrease of LS by transient elastography and fibrosis non-invasive scores can be observed after successful therapy.

摘要

背景

如今，使用新型直接抗病毒药物（DAA）的无干扰素疗法显著提高了不同丙型肝炎病毒（HCV）感染患者群体的治愈率，包括传统上被视为难以治疗的群体（合并感染患者、肝硬化患者和肝移植受者），安全性和耐受性也有显著改善。

目的

介绍我们在肝移植受者中使用DAA疗法的经验，并比较治疗前后的肝脏硬度（LS）和无创纤维化评分。

方法

我们的队列由89例肝移植后基因型1（GT1）复发性丙型肝炎患者组成。76例患者接受了ombitasvir/paritaprevir/ritonavir+dasabuvir+利巴韦林治疗，13例接受了索磷布韦/维帕他韦+/-利巴韦林治疗。在所有患者中，于DAA治疗前和治疗12周后进行了Fibroscan®、FIB4和APRI评分。

结果

我们分析了45例（50.5%）男性和44例（49.5%）女性，平均年龄为55±7.7岁。自肝移植后的中位时间为20.9个月。基线时，53例（59.6%）患者在Fibromax®检查中有严重坏死性炎症；35例（39.4%）肝移植受者有晚期纤维化（F3、F4），33例（37.1%）有3级脂肪变性。治疗结束（EOT）时的病毒学应答（VR）为100%。在意向性分析中，治疗12周后的持续病毒学应答（SVR12）为97.7%，符合方案分析中为100%。在抗病毒治疗开始至SVR12期间，LS有显著改善：从11.9±1.05kPa降至8.8±0.6kPa（p<0.0001），APRI评分（从2.7±0.3降至0.4±0.05，p<0.0001）和FIB4评分（从4.6±0.5降至2.5±0.2，p<0.0001）也有显著改善。