Singh N, Gayowski T, Wannstedt C F, Shakil A O, Wagener M M, Fung J J, Marino I R
Veteran's Affairs Medical Center, Thomas E. Starzl Transplantation Institution, Pittsburgh, Pennsylvania 15240, USA.
Transplantation. 1998 Jan 15;65(1):82-6. doi: 10.1097/00007890-199801150-00016.
In a randomized, controlled trial, we sought to determine whether prophylaxis with interferon-alpha for 6 months had an impact on rate, severity, and timing of onset of recurrent hepatitis C virus (HCV) hepatitis in liver transplant recipients and to assess whether interferon use was associated with rejection in liver transplant recipients.
Twenty-four consecutive liver transplant recipients with HCV were randomized after transplantation to receive either interferon-alpha (3 million U three times weekly) for 6 months or no prophylaxis; median follow-up was 874 days.
Recurrent HCV hepatitis (histopathologically proven) developed in 50% (6 of 12) of the interferon-alpha patients versus 42% (5 of 12) of the control patients (P=NS). Severity of recurrence (as assessed by Knodell score on liver biopsies) also did not differ between the two groups (mean 4.0 for interferon-alpha patients versus 3.5 for control patients, P=NS). Interferon-alpha, however, significantly delayed the timing of occurrence of HCV hepatitis; recurrent HCV hepatitis developed a median of 408 days after transplant in the interferon-alpha group versus 193 days in the control group (P=0.05). No difference in graft or patient survival was demonstrated in the two groups. Rejection episodes, treated with corticosteroids, occurred in 50% (6 of 12) of patients in the interferon-alpha group versus 42% (5 of 12) in the control group (P=NS). Corticosteroid resistant rejection (requiring OKT3) occurred in only one study patient (in the control group).
Interferon-alpha in liver transplant recipients for 6 months delayed the occurrence of HCV hepatitis, but did not decrease the incidence nor the severity of HCV hepatitis after transplantation. Interferon-alpha use was not associated with a higher incidence of rejection compared with the control patients.
在一项随机对照试验中，我们试图确定肝移植受者接受6个月的α干扰素预防治疗是否会对丙型肝炎病毒（HCV）复发型肝炎的发生率、严重程度及发病时间产生影响，并评估使用干扰素是否与肝移植受者的排斥反应相关。
24例连续的HCV肝移植受者在移植后被随机分为两组，一组接受α干扰素（300万单位，每周3次）治疗6个月，另一组不进行预防治疗；中位随访时间为874天。
α干扰素组50%（12例中的6例）发生了复发性HCV肝炎（经组织病理学证实），而对照组为42%（12例中的5例）（P=无显著性差异）。两组复发的严重程度（通过肝脏活检的Knodell评分评估）也无差异（α干扰素组平均为4.0，对照组为3.5，P=无显著性差异）。然而，α干扰素显著延迟了HCV肝炎的发生时间；α干扰素组移植后复发性HCV肝炎发生的中位时间为408天，而对照组为193天（P=0.05）。两组在移植物或患者生存率方面无差异。α干扰素组50%（12例中的6例）患者发生了用皮质类固醇治疗的排斥反应，而对照组为42%（12例中的5例）（P=无显著性差异）。仅1例研究患者（在对照组）发生了对皮质类固醇耐药的排斥反应（需要使用OKT3）。
肝移植受者使用α干扰素6个月可延迟HCV肝炎的发生，但并未降低移植后HCV肝炎的发生率和严重程度。与对照组患者相比，使用α干扰素与较高的排斥反应发生率无关。
