The efficacy of prophylactic interferon alfa-2b in preventing recurrent hepatitis C after liver transplantation
The efficacy of prophylactic interferon alfa-2b in preventing recurrent hepatitis C after liver transplantation
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DOI：
10.1002/hep.510280334
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发表时间：
1998-09-01
期刊：
影响因子：
13.5
通讯作者：
Miller, CM
中科院分区：
文献类型：
--
作者：
Sheiner, PA;Boros, P;Miller, CM
肝移植后丙型肝炎临床复发可导致肝硬化、肝衰竭和死亡。在因丙型肝炎接受肝移植的患者中，我们评估了干扰素α-2b（IFN）预防肝炎复发的疗效。我们将86例患者随机分为IFN组（3 MU，每周三次，从移植后2周内开始，持续1年）或对照组（无IFN）。复发，主要终点，在1年时进行活检或异常生化诊断。HCV RNA水平通过支链DNA（bcDNA）测定法测量，并任意定义为低、中或高（分别为100 x 10（5）Eq/mL）。对30例IFN患者和41例无IFN患者的生存时间大于或等于3个月的数据进行了审查。IFN患者的平均随访时间为669 +/- 228天，无IFN患者为594 +/- 254天。干扰素治疗患者发生复发性肝炎的可能性较低（8例干扰素治疗患者vs. 22例无干扰素治疗患者，P = 0.017，对数秩分析）。IFN和1个月HCV RNA水平是复发的独立预测因子。干扰素使复发风险降低了0.4倍（P=.04，考克斯比例风险模型）;移植后1个月时HCV RNA水平>100 x 105 Eq/mL，风险增加3.1倍（P=.01），低中度，在1个月和3个月的高病毒水平与IFN患者的复发率显著不同相关（1个月时P = 0.05，3个月时P = 0.003），但未接受治疗的患者则不然（1个月时P = 0.28，3个月时P = 0.25）。在有两次或两次以上排斥反应的患者中，复发的风险增加了2.17倍（P= 0.05）。在47例1年活检中（24例干扰素治疗; 23例无干扰素治疗），碎片状坏死在未经治疗的患者中更常见（P
Clinical recurrence of hepatitis C after liver transplantation can lead to cirrhosis, liver failure, and death. In patients undergoing liver transplantation for hepatitis C, we assessed the efficacy of interferon alfa-2b (IFN) in preventing recurrent hepatitis. We randomized 86 patients to either an IFN group (3 MU three times a week starting within 2 weeks after transplantation and continued for 1 year) or a control (no IFN) group. Recurrence, the primary end point, was diagnosed on biopsy performed at 1 year or for abnormal biochemistries. HCV RNA levels were measured by branched-chain DNA (bcDNA) assay and arbitrarily defined as low, moderate, or high (100 x 10(5) Eq/mL, respectively). Data on 30 IFN patients and 41 no-IFN patients who survived greater than or equal to 3 months were reviewed. Mean follow-up was 669 +/- 228 days for IFN patients and 594 +/- 254 days for no-IFN patients. IFN patients were less likely to develop recurrent hepatitis (8 IFN vs. 22 no-IFN patients, P =.017, log rank analysis). IFN and 1-month HCV RNA level were independent predictors of recurrence. IFN reduced the risk of recurrence by a factor of 0.4 (P=.04, Cox proportional hazards model); HCV RNA level >100 x 105 Eq/mL at 1 month after transplantation increased the risk by a factor of 3.1 (P=.01), Low moderate, and high viral levels at 1 and 3 months were associated with significantly different rates of recurrence in IFN patients (P =.05 at 1 month and P =.003 at 3 months) but not in untreated patients (P =.28 at 1 month and P =.25 at 3 months). In patients with two or more rejections, the risk of recurrence was increased by a factor of 2.17 (P=.05), On 47 1-year biopsies (24 IFN; 23 no IFN), piecemeal necrosis was more common in untreated patients (P