Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India.
Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India.
Best Pract Res Clin Gastroenterol. 2020 Jun-Aug;46-47:101689. doi: 10.1016/j.bpg.2020.101689. Epub 2020 Sep 26.
Survival following liver transplantation has changed dramatically owing to improvement in surgical techniques, peri-operative care and optimal immunosuppressive therapy. Post-Liver transplant (LT) de novo or recurrent viral infection continues to cause major allograft dysfunction, leading to poor graft and patient survival in untreated patients. Availability of highly effective antiviral drugs has significantly improved post-LT survival. Patients transplanted for chronic hepatitis B infection should receive life-long nucleos(t)ide analogues, with or without HBIg for effective viral control. Patients with chronic hepatitis C should be commenced on directly acting antiviral (DAA) drugs prior to transplantation. DAA therapy for post-LT recurrent hepatitis C infection is associated with close to 100% sustained virological response (SVR), irrespective of genotype. De novo chronic Hepatitis E infection is an increasingly recognised cause of allograft dysfunction in LT recipients. Untreated chronic HEV infection of the graft may lead to liver fibrosis and allograft failure. CMV and EBV can reactivate leading to systemic illness following liver transplantation. With COVID-19 pandemic, post-transplant patients are at risk of SARS-Co-V2 infection. Majority of the LT recipients require hospitalization, and the mortality in this population is around 20%. Early recognition of allograft dysfunction and identification of viral aetiology is essential in the management of post-LT de novo or recurrent infections. Optimising immunosuppression is an important step in reducing the severity of allograft damage in the treatment of post-transplant viral infections. Viral clearance or control can be achieved by early initiation of high potency antiviral therapy.
由于手术技术、围手术期护理和最佳免疫抑制治疗的改进，肝移植后的存活率发生了巨大变化。肝移植后（LT）新发或复发性病毒感染仍然导致主要移植物功能障碍，导致未经治疗的患者移植物和患者存活率低。高效抗病毒药物的可用性显著提高了 LT 后的生存率。接受慢性乙型肝炎感染移植的患者应终身接受核苷（酸）类似物治疗，无论是否使用 HBIg 以有效控制病毒。慢性丙型肝炎患者应在移植前开始使用直接作用抗病毒（DAA）药物。LT 后复发性丙型肝炎感染的 DAA 治疗与接近 100%的持续病毒学应答（SVR）相关，无论基因型如何。新发慢性戊型肝炎感染是 LT 受者移植物功能障碍的一个日益认识到的原因。未经治疗的移植物慢性 HEV 感染可能导致肝纤维化和移植物衰竭。CMV 和 EBV 可重新激活，导致肝移植后全身疾病。随着 COVID-19 大流行，移植后患者有感染 SARS-Co-V2 的风险。大多数 LT 受者需要住院治疗，该人群的死亡率约为 20%。早期识别移植物功能障碍和确定病毒病因对于 LT 后新发或复发性感染的管理至关重要。优化免疫抑制是减少移植后病毒感染治疗中移植物损伤严重程度的重要步骤。通过早期开始使用高效抗病毒治疗可以实现病毒清除或控制。
