Darema Maria, Cholongitas Evangelos, Filiopoulos Vassilis, Marinaki Smaragdi, Pavlopoulou Ioanna D, Tsoubou Ioanna, Boletis John N, Papatheodoridis George V
Nephrology Department and Transplantation Unit, Laiko Hospital, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
First Department of Internal Medicine, Medical School of National and Kapodistrian University, Athens, Greece.
Ann Gastroenterol. 2020 May-Jun;33(3):285-292. doi: 10.20524/aog.2020.0481. Epub 2020 Apr 14.
The recent interferon-free direct-acting antiviral (DAA) regimens have very good safety and efficacy profiles and are highly recommended for kidney transplant (KT) recipients with chronic hepatitis C (CHC).
All KT recipients with CHC followed at our hospital and who received therapy with the current DAAs were included. At the baseline visit, demographic, clinical and laboratory variables before and after KT, as well as at the commencement of DAAs, at the end of antiviral therapy and the end of follow up, were recorded, including assessment of glomerular filtration rate (eGFR). The changes in eGFR (DGFR) between baseline and end of therapy (1 period), and between end of therapy and end of follow up (2 period), were evaluated.
Twelve KT recipients were retrospectively evaluated: 2 had received antiviral therapy in the past; 4 (33.3%) patients had genotype 1 and 3 (25%) genotype 4 CHC. The median stiffness was 11.9 kPa (range 5-16.8), while 5 patients, none with decompensated cirrhosis, had stiffness >12.5 kPa. Eight patients received a sofosbuvir-containing antiviral regimen (Group 1) and 4 patients received an antiviral regimen without sofosbuvir (Group 2). Eleven (91.7%) patients achieved a sustained virological response (SVR). One patient discontinued DAAs early after treatment and did not achieve SVR. Otherwise, DAAs were well tolerated and no rejection episode was recorded. The DGFRs in the 1 period and 2 period did not differ significantly between Group 1 and Group 2 patients.
In this real-world study of KT recipients with CHC, the high efficacy and clinically acceptable tolerability of DAAs were confirmed.
近期不含干扰素的直接抗病毒药物（DAA）方案具有非常好的安全性和疗效，强烈推荐用于慢性丙型肝炎（CHC）的肾移植（KT）受者。
纳入我院随访的所有接受当前DAA治疗的CHC-KT受者。在基线访视时，记录KT前后以及DAA开始时、抗病毒治疗结束时和随访结束时的人口统计学、临床和实验室变量，包括肾小球滤过率（eGFR）评估。评估基线与治疗结束时（1期）以及治疗结束与随访结束时（2期）eGFR的变化（ΔGFR）。
对12例KT受者进行回顾性评估：2例既往接受过抗病毒治疗；4例（33.3%）患者为基因型1型CHC，3例（25%）为基因型4型CHC。中位硬度为11.9 kPa（范围5 - 16.8），5例患者硬度>12.5 kPa，均无失代偿性肝硬化。8例患者接受含索磷布韦的抗病毒方案（第1组），4例患者接受不含索磷布韦的抗病毒方案（第2组）。11例（91.7%）患者获得持续病毒学应答（SVR）。1例患者治疗早期停用DAA，未获得SVR。此外，DAA耐受性良好，未记录到排斥反应。第1组和第2组患者在1期和2期的ΔGFR无显著差异。
在这项针对CHC-KT受者的真实世界研究中，证实了DAA具有高疗效和临床可接受的耐受性。
