Department of Pharmacy, 21668University of Maryland Medical Center, Baltimore, MD, USA.
Department of Surgery, 21668University of Maryland School of Medicine, Baltimore, MD, USA.
J Pharm Pract. 2023 Apr;36(2):264-270. doi: 10.1177/08971900211034261. Epub 2021 Jul 21.
Direct-acting antivirals for the treatment of hepatitis C virus (HCV) have improved outcomes in liver transplant recipients (LTRs). However, the timing of HCV treatment and approach to treating rejection have not been well described. Additionally, pharmacists' roles in these comprehensive areas have not been investigated. This single-center, retrospective, cohort review compared 1-year graft and patient survival between HCV-positive and HCV-negative LTRs. Secondary endpoints included 1-year rejection rates, HCV sustained virologic response and time to HCV treatment. Ninety-two HCV Nucleic Acid Amplification Test (NAT)-positive LTRs were matched 1:1 to HCV-seronegative LTRs. One-year graft and patient survival were similar between groups. HCV-positive LTRs were more likely to experience biopsy-proven acute rejection (BPAR), and despite treatment with pulse steroids, there was no impact on graft survival or occurrence of fibrosing cholestatic hepatitis (FCH). Time to HCV treatment was 5.4-6.4 months post-transplant, with no treatment failures or impact on graft or patient survival. No difference was seen in graft survival at 1 year between HCV-positive and HCV-seronegative LTRs. Delayed time to treatment of HCV and treatment of rejections in the HCV-positive cohort did not impact outcomes. However, pharmacist-driven protocols could ensure more efficient initiation of HCV treatment in the future.
直接作用抗病毒药物治疗丙型肝炎病毒（HCV）已改善肝移植受者（LTR）的预后。然而，HCV 治疗的时机和排斥反应的治疗方法尚未得到很好的描述。此外，药师在这些综合领域的作用尚未得到研究。
本单中心回顾性队列研究比较了 HCV 阳性和 HCV 阴性 LTR 患者的 1 年移植物和患者存活率。次要终点包括 1 年排斥反应发生率、HCV 持续病毒学应答和 HCV 治疗时间。92 例 HCV 核酸扩增试验（NAT）阳性 LTR 与 HCV 血清阴性 LTR 1:1 匹配。两组 1 年移植物和患者存活率相似。HCV 阳性 LTR 更易发生经活检证实的急性排斥反应（BPAR），尽管接受脉冲类固醇治疗，但对移植物存活率或发生纤维性胆汁淤积性肝炎（FCH）无影响。HCV 治疗的时间为移植后 5.4-6.4 个月，无治疗失败或对移植物或患者存活率的影响。HCV 阳性和 HCV 血清阴性 LTR 患者在 1 年时的移植物存活率无差异。HCV 阳性队列中 HCV 治疗和排斥反应治疗的延迟时间并未影响结局。然而，药剂师驱动的方案可以确保未来 HCV 治疗的更有效启动。
