McCain Josiah D, Chascsa David M
Department of Gastroenterology & Hepatology, Mayo Clinic, Phoenix, AZ, USA.
Transplant Center, Mayo Clinic, Phoenix, AZ, USA.
Hepat Med. 2022 Apr 29;14:27-36. doi: 10.2147/HMER.S282662. eCollection 2022.
Modern therapies for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus have become so effective that patients treated for these conditions can have normal life-expectancies. Suitable livers for transplantation remain a scarce and valuable resource. As such, significant efforts have been made to expand donation criteria at many centers. This constant pressure, coupled with the increasing effectiveness of antiviral therapies, has meant that more and more patients infected with hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) may be considered appropriate donors in the right circumstances. Patients with these infections are also more likely to be considered appropriate transplantation recipients than in the past. The treatment of HBV, HCV, and HIV after liver transplantation (LT) can be challenging and complicated by viral coinfections. The various pharmaceutical agents used to treat these infections, as well as the immunosuppressants used post-LT must be carefully balanced for maximum efficacy, and to avoid resistance and drug-drug interactions.
用于治疗乙型肝炎病毒、丙型肝炎病毒和人类免疫缺陷病毒的现代疗法已经变得非常有效，以至于接受这些疾病治疗的患者可以拥有正常的预期寿命。适合移植的肝脏仍然是一种稀缺且宝贵的资源。因此，许多中心都在努力扩大捐赠标准。这种持续的压力，再加上抗病毒疗法有效性的不断提高，意味着在适当的情况下，越来越多感染乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）和人类免疫缺陷病毒（HIV）的患者可能被视为合适的捐赠者。与过去相比，感染这些病毒的患者也更有可能被视为合适的移植受者。肝移植（LT）后对HBV、HCV和HIV的治疗可能具有挑战性，并且会因病毒合并感染而变得复杂。用于治疗这些感染的各种药物以及LT后使用的免疫抑制剂必须仔细平衡，以实现最大疗效，并避免耐药性和药物相互作用。
