在法国多中心研究中接受 HCV 感染治疗并被列入肝移植名单的患者：五年后会怎样？
Patients Treated for HCV Infection and Listed for Liver Transplantation in a French Multicenter Study: What Happens at Five Years?
机构信息
Montpellier Saint Eloi University Hospital, 80 Avenue Augustin Fliche, 34090 Montpellier, France.
Nouvelles Technologies, AESIO Santé, 34070 Montpellier, France.
出版信息
Viruses. 2022 Dec 31;15(1):137. doi: 10.3390/v15010137.
BACKGROUND
Direct-acting antiviral (DAA) agents for the treatment of hepatitis C virus (HCV) infection have been proven safe and effective in cirrhotic patients awaiting liver transplantation (LT). However, in the long term, data remain minimal regarding the clinical impact of viral eradication on patients listed for decompensated cirrhosis or hepatocellular carcinoma (HCC). We aimed to elucidate the clinical outcomes of patients regarding delisting and the evolution of HCC during the long-term follow-up.
METHODS
An observational, multicenter, retrospective analysis was carried out on prospectively collected data from HCV-positive patients treated with an interferon-free regimen while awaiting LT in 18 French hospitals.
RESULTS
A total of 179 patients were included in the study. The indication for LT was HCC in 104 (58.1%) patients and cirrhosis in 75 (41.9%) patients. The sustained virological response was 84.4% and the treatment was well tolerated. At five years, among 75 patients with cirrhosis treated for HCV, 19 (25.3%) were delisted following improvement after treatment. Predictive factors for delisting highlighted an absence of ascites, MELD score ≤ 15, and Child-Pugh score ≤ 7. No patients with refractory ascites were delisted. Among patients with HCC, 82 (78.9%) were transplanted. The drop-out rate was low (6.7%) and few recurrences of HCC after LT were observed.
CONCLUSIONS
DAAs are safe and effective in patients awaiting LT for cirrhosis or HCC. A quarter of patients with cirrhosis can be delisted because of clinical improvement. Predictive factors for delisting, as a result of improvement, may assist prescribers, before initiating HCV infection therapy in the long-term perspective.
背景
直接作用抗病毒（DAA）药物已被证明可安全有效地治疗等待肝移植（LT）的丙型肝炎病毒（HCV）感染患者。然而，从长期来看，关于病毒清除对失代偿性肝硬化或肝细胞癌（HCC）患者的临床影响的数据仍然很少。我们旨在阐明患者在失代偿性肝硬化或 HCC 长期随访期间因除名和 HCC 进展而导致的临床结局。
方法
对 18 家法国医院前瞻性收集的 HCV 阳性患者接受无干扰素方案治疗并等待 LT 的数据进行了一项观察性、多中心、回顾性分析。
结果
共有 179 例患者纳入本研究。LT 的指征为 HCC 104 例（58.1%）和肝硬化 75 例（41.9%）。持续病毒学应答率为 84.4%，治疗耐受性良好。在 75 例因 HCV 治疗的肝硬化患者中，有 19 例（25.3%）在治疗后病情改善后被除名。除名的预测因素包括无腹水、MELD 评分≤15 和 Child-Pugh 评分≤7。没有难治性腹水患者被除名。在 HCC 患者中，82 例（78.9%）接受了移植。失访率低（6.7%），LT 后 HCC 复发很少。
结论
DAA 在等待 LT 的肝硬化或 HCC 患者中是安全有效的。四分之一的肝硬化患者可因临床改善而除名。改善后的除名预测因素可能有助于临床医生在长期角度考虑开始 HCV 感染治疗之前做出决策。
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