Curing Hepatitis C in Liver Transplant Recipients Is Associated with Changes in Immunosuppressant Use.
Curing Hepatitis C in Liver Transplant Recipients Is Associated with Changes in Immunosuppressant Use.
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DOI：
10.14218/jcth.2016.00001
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发表时间：
2016-03-28
影响因子：
3.6
通讯作者：
Busuttil RW
中科院分区：
文献类型：
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作者：
Saab S;Rheem J;Jimenez M;Bau S;Choi G;Durazo F;El Kabany M;Han S;Farid A;Jamal N;Grotts J;Elashoff D;Busuttil RW
背景和目的：全口服不含干扰素的抗病毒药物在治疗肝移植(LT)受者丙型肝炎复发感染方面是非常有效的。这项研究的目的是评估在实现持续病毒应答(SVR)后的免疫抑制需求。方法：我们比较了用全口服直接作用药物治疗复发性丙型肝炎的成人肝移植受者在达到SVR前后的免疫抑制需求。结果：我们确定了52名接受肝移植治疗的受者，他们实现了SVR。中位年龄(25%和75%四分位数范围[IQR])为62岁(57.75，65)。大多数受试者接受了他克莫司(TAC)作为免疫抑制方案。在达到SVR后，未经调整的每体重每日TAC剂量没有统计学差异(p>；0.05)。然而，调整后的每日每体重TAC剂量、血清TAC水平以及肾小球滤过率和TAC的乘积在统计学上有显著下降。未经调整/经调整的环孢素每日剂量或血清浓度在统计学上没有显着差异。结论：接受TAC治疗的患者免疫抑制需求增加，但环孢素未见增加。处方TAC的LT受者在治疗完成后需要密切监测，以避免潜在的急性排斥风险。
Background and Aims: All-oral interferon-free antivirals are highly effective in treating recurrent hepatitis C (HCV) infection in liver transplant (LT) recipients. The aim of the study was to assess immunosuppression needs after achieving a sustained viral response (SVR). Methods: We compared immunosuppression needs before and after achieving a SVR in adult LT recipients treated for recurrent HCV infection with all-oral direct acting agents. Results: We identified 52 liver LT treated recipients who achieved a SVR. The median (25th and 75th percentile interquartile range [IQR]) age was 62 years (57.75, 65). Most recipients received tacrolimus (TAC) for their immunosuppressant regimen. After achieving SVR, there was no statistically significant difference in daily dose of TAC unadjusted per weight (p > 0.05). However, there was a statistically significant decrease in daily dose of TAC adjusted per weight, serum levels of TAC, and the product of glomerular filtration rate and TAC. No statistically significant differences in cyclosporine unadjusted/adjusted per weight daily dose or serum levels were noted. Conclusions: Immunosuppression needs were increased for those patients treated with TAC but not cyclosporine. LT recipients prescribed TAC require close monitoring after treatment completion to avoid potential risk of acute rejection.