Benefit of sustained virological response to combination therapy on graft survival of liver transplanted patients with recurrent chronic hepatitis C
Benefit of sustained virological response to combination therapy on graft survival of liver transplanted patients with recurrent chronic hepatitis C
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DOI：
10.1111/j.1600-6143.2005.00976.x
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发表时间：
2005-08-01
影响因子：
8.8
通讯作者：
Trepo, C
中科院分区：
文献类型：
--
作者：
Bizollon, T;Pradat, P;Trepo, C
丙型肝炎反复感染是肝移植后进行性纤维化、肝硬化和移植物失功的重要原因。移植后复发的治疗导致高达30%的病例出现持续病毒学应答（SVR）。本研究的目的是评估SVR对患者和移植物存活的影响。纳入了34例对IFN-利巴韦林具有SVR的患者。46名对联合治疗无反应者组成对照组。每6个月记录一次随访数据，包括HCV RNA和临床问题（肝硬化、失代偿、肝细胞癌、死亡）的发生。每年进行移植物活检。应答者的平均随访时间为52个月，无应答者为57个月。每组患者中有2例患者死亡。2例SVR患者出现晚期病毒学复发。38%的SVR患者的纤维化减少，44%保持稳定，18%恶化。相比之下，大多数无应答患者的纤维化增加（74%，p < 0.001）。在随访结束时，入选时无肝硬化的患者均未发生移植物肝硬化，而无应答患者中有9例发生移植物肝硬化（p = 0.009）。两组患者的生存率无差异。总之，这项研究表明，HCV根除对移植物存活率有积极的影响。
Recurrent hepatitis C infection is an important cause of progressive fibrosis, cirrhosis and graft loss after liver transplantation. Treatment for post-transplant recurrence results in sustained virological response (SVR) in up to 30% of cases. The aim of this study was to evaluate the impact of SVR on patients and graft survival. Thirty-four patients with an SVR to IFN-ribavirin were included. Forty-six nonresponders to the combination formed the control group. Follow-up data were recorded every 6 months and included HCV RNA, and the occurrence of clinical problems (cirrhosis, decompensation, hepatocellular carcinoma, death). A graft biopsy was performed every year. The mean follow-up duration was 52 months in responders and 57 months in nonresponders. Two patients died in each group of patients. Two patients with SVR developed late virological relapse. Fibrosis decreased in 38% of patients with SVR, remained stable in 44% and worsened in 18%. In contrast, fibrosis increased in the majority of nonresponder patients (74%, p < 0.001). At the end of follow-up, no patient without cirrhosis at inclusion developed cirrhosis of the graft versus 9 among nonresponder patients (p = 0.009). No difference in patient survival was observed in the two groups. In conclusion, this study shows that HCV eradication has a positive impact on graft survival.