Immunosuppression and HCV recurrence after liver transplantation
Immunosuppression and HCV recurrence after liver transplantation
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DOI：
10.1016/j.jhep.2011.06.031
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发表时间：
2012-04-01
影响因子：
25.7
通讯作者：
Burroughs, Andrew K.
中科院分区：
文献类型：
--
作者：
Samonakis, Dimitrios N.;Germani, Giacomo;Burroughs, Andrew K.
HCV相关肝病是肝移植最常见的指征。丙型肝炎病毒感染的复发是普遍的，对患者和移植物的生存有重大影响。免疫抑制是导致复发性HCV感染加速复发和缩短自然病程的主要因素。积累的经验为支持免疫抑制方案的某些策略提供了数据。从现有的证据来看，反复服用皮质类固醇治疗和抗淋巴细胞抗体治疗排斥反应会导致更严重的复发。低剂量和缓慢减量类固醇比高剂量维持和/或快速减量更好。最近的荟萃分析倾向于无类固醇方案，但这些解释很复杂，因为没有类固醇可能只是代表免疫效力较低。他克莫司和环孢素治疗方案在HCV复发方面没有差异，但他克莫司增加了HCV移植患者的移植物和患者生存率。维持硫唑嘌呤6个月或更长时间可能有有益效果。没有确凿的证据表明霉酚酸盐和白细胞介素-2受体阻滞剂有益。关于mTOR抑制剂的数据很少。需要更好的证据来确定HCV受体的最佳免疫抑制方案，需要进行更多的随机试验。(C) 2011年欧洲肝脏研究协会。Elsevier B.V.版权所有。
HCV related liver disease is the most common indication for liver transplantation. Recurrence of HCV infection is universal and has a substantial impact on patient and graft survival. Immunosuppression is a major factor responsible for the accelerated recurrence and compressed natural history of recurrent HCV infection. Accumulating experience has provided data to support certain strategies for immunosuppressive regimens.From the available evidence, more severe recurrence results from repeated bolus corticosteroid therapy and anti-lymphocyte antibodies used to treat rejection. Low dose and slow tapering of steroids are better than high dose maintenance and/or rapid tapering. Recent meta-analyses favour steroid-free regimens but these are complicated to interpret as the absence of steroids may simply represent less immunopotency. There is no difference in HCV recurrence between tacrolimus and cyclosporine regimens, but tacrolimus increases graft and patient survival in HCV transplanted patients. There may be a beneficial effect of maintenance azathioprine given for 6 months or longer.There is no conclusive evidence for benefit of mycophenolate and interleukin-2 receptor blockers. Few data are available for mTOR inhibitors. Better evidence is needed to establish the optimal immunosuppressive regimen for HCV recipients and more randomized trials should be performed. (C) 2011 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.