慢性肾脏病及肾移植背景下丙型肝炎病毒感染的管理进展
Update on the Management of Hepatitis C Virus Infection in the Setting of Chronic Kidney Disease and Kidney Transplantation.
作者信息
Latt Nyan L
机构信息
Dr Latt is a transplant hepatologist in the Section of Gastroenterology and Hepatology at the Ochsner Multi-Organ Transplant Institute in New Orleans, Louisiana, and a senior lecturer at the University of Queensland Ochsner Clinical School in Queensland, Australia.
出版信息
Gastroenterol Hepatol (N Y). 2018 Dec;14(12):687-705.
Hepatitis C virus (HCV) infection is one of the major global health burdens. Chronic HCV infection can increase the risks of proteinuria and chronic kidney disease (CKD), as well as cause various types of glomerulonephritides. This article provides an update on the management of patients with HCV infection with CKD and a kidney transplantation. Newer direct-acting antiviral (DAA) agents are safe and effective in eliminating HCV infection in patients with CKD and in kidney transplant recipients. Society guidelines recommend elbasvir/grazoprevir and glecaprevir/pibrentasvir for HCV-infected patients with CKD stage 4 or 5, including patients on hemodialysis. Patients with CKD stages 1 to 3 with HCV infection can be treated with various sofosbuvir-based regimens. Major clinical trials have demonstrated the safety, efficacy, and feasibility of the use of DAA agents in treating HCVuninfected kidney transplant recipients of HCV-infected donors. The utilization of HCV-infected kidney donors may decrease kidney transplant waiting list mortality and reduce the donated kidney discard rate.
丙型肝炎病毒（HCV）感染是全球主要的健康负担之一。慢性HCV感染会增加蛋白尿和慢性肾脏病（CKD）的风险，还会引发各种类型的肾小球肾炎。本文提供了关于合并CKD的HCV感染患者及肾移植患者管理的最新信息。新型直接抗病毒（DAA）药物在消除CKD患者及肾移植受者的HCV感染方面安全有效。学会指南推荐elbasvir/grazoprevir和glecaprevir/pibrentasvir用于CKD 4期或5期的HCV感染患者，包括接受血液透析的患者。HCV感染的CKD 1至3期患者可用各种基于索磷布韦的方案进行治疗。主要临床试验已证明，在治疗来自HCV感染供体的未感染HCV的肾移植受者时，使用DAA药物具有安全性、有效性和可行性。利用HCV感染的肾供体可能会降低肾移植等待名单上的死亡率，并降低捐赠肾脏的丢弃率。
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