Platz K P, Mueller A R, Berg T, Neuhaus R, Hopf U, Lobeck H, Neuhaus P
Department of Surgery, Virchow Clinic, Humboldt University Berlin, Germany.
Transpl Int. 1998;11 Suppl 1:S209-11. doi: 10.1007/s001470050463.
The optimal immunosuppressive regimen in patients transplanted for hepatitis C (HCV) is still under discussion. High immunosuppression may promote viral replication and recurrent graft hepatitis. But acute and chronic rejection frequently seen in conjunction with HCV recurrence may require some rescue therapy. One hundred and thirty-seven patients transplanted for HCV cirrhosis, who were HCV-RNA positive prior to transplantation, were analyzed. Seventy-nine patients received CSA-based immunosuppression and 58 patients FK506-based immunosuppression. One-month patient survival was 100% in both groups. Three month and 1-year survival rates and the cumulative 1-5-year patient survival was similar in CsA-treated [67/79 (84.8%)] and FK506-treated patients [50/58 (86.2%)]. Retransplantations for HCV recurrence were performed in 5.1% of CsA-treated patients and 6.9% of FK506-treated patients; it was successful in 50% and 75% of patients, respectively. Conversion from CsA to FK506 and vice versa was high with 25 out of 79 patients (31.6%) converting in the CsA group and 8 out of 58 patients (13.8%) converting in the FK506 group. Conversion to FK506 was performed due to acute and chronic rejection and to CsA because of toxicity and HCV recurrence. In both groups, 25% of converted patients died. Five patients of the CsA group and 9 of the FK506 group received OKT3; more than one-third of each group died. Five patients in the CsA group and 6 in the FK506 group received mycophenolate mofetil (MMF) for HCV recurrence or acute and chronic rejection in conjunction with HCV recurrence. All patients of this critical group are alive with good graft function. In conclusion, survival rates of HCV patients were similar to those seen for other indications. Conversion from CsA to FK506 and vice versa was high and reflects a critical group concerning patient survival. OKT3 treatment should be avoided. A promising therapeutic option for critical patients experiencing acute or chronic rejection in conjunction with HCV recurrence may be treatment with MMF.
丙型肝炎（HCV）移植患者的最佳免疫抑制方案仍在讨论中。高强度免疫抑制可能会促进病毒复制和移植肝复发性肝炎。但与HCV复发同时出现的急性和慢性排斥反应可能需要一些挽救治疗。对137例因HCV肝硬化接受移植且移植前HCV-RNA呈阳性的患者进行了分析。79例患者接受了以环孢素A（CSA）为基础的免疫抑制治疗，58例患者接受了以他克莫司（FK506）为基础的免疫抑制治疗。两组患者1个月的生存率均为100%。CSA治疗组[67/79（84.8%）]和FK506治疗组[50/58（86.2%）]的3个月和1年生存率以及1至5年的累积生存率相似。CSA治疗组5.1%的患者和FK506治疗组6.9%的患者因HCV复发接受了再次移植；分别有50%和75%的患者再次移植成功。从CSA转换为FK506以及反之的比例很高，CSA组79例患者中有25例（31.6%）转换，FK506组58例患者中有8例（13.8%）转换。转换为FK506是由于急性和慢性排斥反应，转换为CSA是由于毒性和HCV复发。两组中，转换患者的死亡率均为25%。CSA组5例患者和FK506组9例患者接受了OKT3治疗；每组超过三分之一的患者死亡。CSA组5例患者和FK506组6例患者因HCV复发或与HCV复发相关的急性和慢性排斥反应接受了霉酚酸酯（MMF）治疗。该危急组的所有患者均存活且移植肝功能良好。总之，HCV患者的生存率与其他适应证患者相似。从CSA转换为FK506以及反之的比例很高，这反映了一个关乎患者生存的危急组。应避免使用OKT3治疗。对于伴有HCV复发的急性或慢性排斥反应的危急患者，一个有前景的治疗选择可能是MMF治疗。
