Unidad de Hepatología y Trasplante de Hígado, Departamento de Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Ciudad de México, México.
Department of Biostatistics, University of Washington, Seattle, Washington.
Arch Med Res. 2021 Oct;52(7):713-718. doi: 10.1016/j.arcmed.2021.04.003. Epub 2021 May 7.
Hepatitis C virus (HCV) infection is one of the most frequent causes of liver transplantation (LT) worldwide. Patients with HCV viremia at the time of LT universally develop recurrent HCV in the allograft, leading to accelerated fibrosis and graft loss. Treatment with direct-acting antivirals (DAA) is highly effective and safe in this population.
To describe the efficacy and safety of DAA in treating post LT HCV recurrence in a Mexican cohort.
We designed a retrospective cohort study that included all LT patients from 2000-2019 with HCV recurrence after LT who received DAA. Clinical and biochemical characteristics were collected from clinical records. Patients who received treatment before LT and those who received interferon-based therapies after LT achieving sustained viral response at 12 weeks were excluded; patients who didn´t complete DAA therapy were eliminated. The primary outcome was SVR-12.
Fifty-six patients received DAA after the LT with 98% SVR-12. The most frequent genotypes were 1b (54%) and 1a (34%). The most common antiviral scheme used was sofosbuvir/ledipasvir for 12 weeks in 59% of the patients. No severe adverse effects were observed. Ribavirin was used in 82% of the patients, of which 23.9% had adverse effects, mostly mild. The median follow-up after LT was 55 months (IQR 43-51), with a global and graft survival at one and three years of 100%.
In a Mexican cohort, DAA therapy in LT patients with recurrence of HCV infection showed high efficacy and an acceptable safety profile.
丙型肝炎病毒（HCV）感染是全球范围内导致肝移植（LT）最常见的原因之一。在 LT 时患有 HCV 血症的患者在移植物中普遍会出现 HCV 复发，导致纤维化加速和移植物丢失。在该人群中，直接作用抗病毒药物（DAA）治疗具有高度有效性和安全性。
描述 DAA 在治疗墨西哥队列中 LT 后 HCV 复发的疗效和安全性。
我们设计了一项回顾性队列研究，纳入了 2000 年至 2019 年间所有 LT 后 HCV 复发并接受 DAA 治疗的患者。从临床记录中收集了临床和生化特征。排除了在 LT 前接受治疗和在 LT 后接受干扰素为基础的治疗并在 12 周时达到持续病毒学应答的患者；未完成 DAA 治疗的患者被排除。主要结局是 SVR-12。
56 例患者在 LT 后接受了 DAA 治疗，其中 98%达到了 SVR-12。最常见的基因型是 1b（54%）和 1a（34%）。最常用的抗病毒方案是索磷布韦/维帕他韦治疗 12 周，占 59%。未观察到严重不良反应。利巴韦林在 82%的患者中使用，其中 23.9%出现不良反应，大多为轻度。LT 后中位随访时间为 55 个月（IQR 43-51），全球和移植物 1 年和 3 年存活率均为 100%。
在墨西哥队列中，DAA 治疗 LT 患者 HCV 感染复发显示出高效性和可接受的安全性。
