Shoreibah Mohamed, Romano John, Sims Omar T, Guo Yuqi, Jones DeAnn, Venkata Krishna, Kommineni Vishnu, Orr Jordan, Fitzmorris Paul, Massoud Omar I
Division of Gastroenterology & Hepatology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Internal Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
J Clin Transl Hepatol. 2018 Dec 28;6(4):391-395. doi: 10.14218/JCTH.2018.00026. Epub 2018 Jul 11.
Hepatitis C Virus (HCV) is uniformly recurrent after liver transplant (LT) and recurrence is associated with an increased risk of mortality. Immunosuppressive medications increase the risk of chronic kidney disease, and the presence of chronic kidney disease presents a challenge for HCV treatment in LT recipients. The aim of this study was to assess changes in glomerular filtration rates (GFRs) of LT recipients receiving HCV treatment. This is a retrospective study of LT patients who received HCV treatment between 2015 and 2016 ( = 60). The outcomes of interest were differences in serum creatinine levels and in GFR, measured at treatment initiation and at 24 weeks after treatment. The average age of the patients was 59 years-old, and 17% were cirrhotic and 67% were treatment-experienced. All patients received sofosbuvir/ledipasvir without ribavirin. All patients achieved sustained virologic response at 12 weeks after treatment (SVR12). At baseline, 55% of patients had GFR <60 mL/min per 1.73 m. Among those patients, GFR did not change in 18%, 33% had improved GFR, and 48% had worsened GFR. Up to 45% of the patients had a GFR >60 mL/min per 1.73 m. Among those patients, GFR did not change in 81%, and 19% had worsened GFR. In the entire cohort, 65% of patients had improved or stable GFR and 35% had worsened GFR. The average change in serum creatinine between baseline and 24 weeks was 0.10 ( = 0.18). This study showed improved or unchanged GFR in 65% and worsened GFR in 35% of LT recipients who achieved SVR12. Worsening of GFR was more frequently encountered in those with impaired renal function at baseline. Caution should be used when treating HCV in LT recipients, especially those with baseline status of renal impairment.
丙型肝炎病毒（HCV）在肝移植（LT）后普遍复发，且复发与死亡风险增加相关。免疫抑制药物会增加慢性肾脏病的风险，而慢性肾脏病的存在给LT受者的HCV治疗带来了挑战。本研究的目的是评估接受HCV治疗的LT受者肾小球滤过率（GFR）的变化。这是一项对2015年至2016年间接受HCV治疗的LT患者的回顾性研究（n = 60）。感兴趣的结果是治疗开始时和治疗后24周时血清肌酐水平和GFR的差异。患者的平均年龄为59岁，17%为肝硬化患者，67%有治疗经历。所有患者均接受了不含利巴韦林的索磷布韦/维帕他韦治疗。所有患者在治疗后12周均实现了持续病毒学应答（SVR12）。基线时，55%的患者GFR<60 mL/（min·1.73 m²）。在这些患者中，18%的患者GFR未改变，33%的患者GFR有所改善，48%的患者GFR恶化。高达45%的患者GFR>60 mL/（min·1.73 m²）。在这些患者中，81%的患者GFR未改变，19%的患者GFR恶化。在整个队列中，65%的患者GFR有所改善或稳定，35%的患者GFR恶化。基线和24周时血清肌酐的平均变化为0.10（标准差 = 0.18）。本研究表明，在实现SVR12的LT受者中，65%的患者GFR有所改善或未改变，35%的患者GFR恶化。基线时肾功能受损的患者中更常出现GFR恶化的情况。在治疗LT受者的HCV时应谨慎，尤其是那些基线存在肾功能损害的患者。
