Direct-acting antiviral regimens are safe and effective in the treatment of hepatitis C in simultaneous liver-kidney transplant recipients
Direct-acting antiviral regimens are safe and effective in the treatment of hepatitis C in simultaneous liver-kidney transplant recipients
复制标题
DOI：
10.1111/ctr.13198
复制
发表时间：
2018-03-01
影响因子：
2.1
通讯作者：
Smith, Coleman
中科院分区：
文献类型：
--
作者：
Nookala, Anupama U.;Crismale, James;Smith, Coleman
丙型肝炎 (HCV) 仍然是导致同步肝/肾移植 (SLKT) 的终末期肝病的最常见病因，并且与非 HCV 患者相比，移植后存活率较差。我们的目的是评估全口服直接作用抗病毒（DAA）药物联合或不联合利巴韦林（RBV）治疗 SLKT 后 HCV 复发的有效性和耐受性。对 34 名患者进行了回顾性研究，主要由未接受治疗的患者 (73.5%) 和感染基因型 1a (64.7%) 的非白人 (61.8%) 男性 (82.4%) 组成。 94.1% 的患者在 24 周后达到持续病毒学应答 (SVR)（32/34 名患者），治疗 12 周和 24 周之间没有差异。 64.7%没有临床副作用。发生三例死亡，均与治疗无关。一名患者出现肝脏排斥反应；增加他克莫司的剂量并开始使用泼尼松，同时继续 HCV 治疗，患者最终实现了 SVR。无肝移植损失。无肾脏排斥或损失。我们证明，DAA 联合或不联合 RBV 均可产生显着的 SVR 率，并且大多数研究的 SLKT 患者都可以耐受。等到肾移植后进行治疗是安全的，因此可以增加这些患者的供体库。我们的队列是多元化的，这使得我们的结果具有普遍性。
Hepatitis C (HCV) remains the single most common etiology of end-stage liver disease leading to simultaneous liver/kidney transplant (SLKT) and has worse post-transplant survival compared to non-HCV patients. We aim to assess the effectiveness and tolerance of the all-oral direct-acting antiviral (DAA) agents with or without ribavirin (RBV) in the treatment of HCV recurrence post-SLKT. Thirty-four patients were studied retrospectively, composed predominantly of treatment-naive (73.5%) non-Caucasian (61.8%) males (82.4%) infected with genotype 1a (64.7%). 94.1% reached a sustained virologic response (SVR) after 24weeks (32/34 patients), without difference between 12 and 24weeks of therapy. 64.7% had no clinical side effects. Three deaths occurred, all unrelated to treatment. One patient had liver rejection; tacrolimus was increased and prednisone was initiated while HCV treatment was continued and the patient ultimately achieved SVR. No liver graft losses. No kidney rejection or losses. We demonstrated that DAA combinations with or without RBV result in a remarkable SVR rate and tolerated in the majority of the studied SLKT patients. It is safe to wait to treat until post-kidney transplant and therefore increase the donor pool for these patients. Our cohort is ethnically diverse, making our results generalizable.