Two patients treated with pegylated interferon/ribavirin/telaprevir triple therapy for recurrent hepatitis C after living donor liver transplantation.
Two patients treated with pegylated interferon/ribavirin/telaprevir triple therapy for recurrent hepatitis C after living donor liver transplantation.
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两名患者在活体肝移植后接受聚乙二醇干扰素/利巴韦林/特拉匹韦三联疗法治疗复发性丙型肝炎。
DOI：
10.1111/hepr.12296
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发表时间：
2014
期刊：
影响因子：
4.2
通讯作者：
and Chayama K
中科院分区：
文献类型：
--
作者：
Kawaoka T. Takahashi S. Tatsukawa Y. Hiramatsu A. Hiraga N. Miki D. Tsuge M. Imamura M. Kawakami Y. Aikata H. Ochi H. Ishiyama K. Ide K. Tashiro H. Ohdan H;and Chayama K
在肝移植术后复发的丙型肝炎病毒感染患者中，由于与免疫抑制药物的相互作用，很难使用蛋白水解酶抑制剂。我们报告了两名患者接受TVR联合聚乙二醇化干扰素/利巴韦林(聚乙二醇化干扰素/利巴韦林)治疗肝移植后复发的丙型肝炎病毒1型感染的经验。第一例为63岁的丙型肝炎病毒相关性肝硬变患者，肝移植后干扰素-β联合rbv治疗无效。治疗切换为聚乙二醇干扰素-α-2b+红斑狼疮，并开始治疗。供者携带白细胞介素28单核苷酸多态(SNP)TT基因(Rs8099917)。受者携带IL-28SNP的TT基因(Rs8099917)。完成12周的三联治疗后，给予聚乙二醇干扰素-α-2b+RBV，共36 周。最后，他持续了病毒式的反应。第二例是一名70岁的女性，患有丙型肝炎病毒相关性肝硬变和肝细胞癌。移植后对聚乙二醇干扰素-α-2b加rbv无效，随后改用聚乙二醇干扰素-α-2b/rbv/rvr。供者IL-28SNP为TG型，受者为TT型。血清HCVRNA滴度在5 周降至检测下限以下。然而，由于全身疲劳，三联疗法在11 周被取消，导致4 后HCVRNA反弹。两名患者都接受了环孢素治疗，从小剂量开始，以避免与TVR的相互作用。TVR是一种潜在的适合于移植后对聚乙二醇干扰素-α-2b和RBV无效的移植受者的药物。
It is difficult to use protease inhibitors in patients with recurrent hepatitis C virus (HCV) infection after liver transplantation (LT) due to interaction with immunosuppressive drugs. We report our experience with two patients treated with telaprevir (TVR) combined with pegylated interferon/ribavirin (PEG IFN/RBV) for recurrent HCV genotype 1 infection after LT. The first was a 63‐year‐old man with HCV‐related liver cirrhosis, who failed to respond to IFN‐β plus RBV after LT. Treatment was switched to PEG IFN‐α‐2b plus RBV and TVR was started. The donor had TT genotype of interleukin (IL)‐28 single nucleotide polymorphisms (SNP) (rs8099917). The recipient had TT genotype of IL‐28 SNP (rs8099917). Completion of 12‐week triple therapy was followed by PEG IFN‐α‐2b plus RBV for 36 weeks. Finally, he had sustained viral response. The second was a 70‐year‐old woman with HCV‐related liver cirrhosis and hepatocellular carcinoma. She failed to respond to PEG IFN‐α‐2b plus RBV after LT, and was subsequently switched to PEG IFN‐α‐2b/RBV/TVR. Genotype analysis showed TG genotype of IL‐28 SNP for the donor, and TT genotype of IL‐28 SNP for the recipient. Serum HCV RNA titer decreased below the detection limit at 5 weeks. However, triple therapy was withdrawn at 11 weeks due to general fatigue, which resulted in HCV RNA rebound 4 weeks later. Both patients were treated with cyclosporin, starting with a small dose to avoid interactions with TVR. TVR is a potentially suitable agent for LT recipients who do not respond to PEG IFN‐α‐2b plus RBV after LT.