Safe and effective treatment with daclatasvir and asunaprevir in a liver transplant recipient with severe cholestatic hepatitis C
Safe and effective treatment with daclatasvir and asunaprevir in a liver transplant recipient with severe cholestatic hepatitis C
复制标题
达卡他韦和阿舒瑞韦治疗患有严重胆汁淤积性丙型肝炎的肝移植受者安全有效
作者：
Y. Ueda;T. Kaido;E. Hatano;S. Ohtsuru;S. Uemoto
重度淤胆型丙型肝炎(SCH)是肝移植后复发丙型肝炎的一种独特变种。遗憾的是，SCH的预后很差，干扰素(干扰素)治疗并未改善预后。我们在此报告一例进展性SCH伴急性细胞排斥反应(ACR)和细菌感染的病例，成功地用达拉他韦和阿昔洛韦进行了无干扰素治疗。1例43岁男性在肝移植后第48天被诊断为SCH和轻度ACR，并开始使用达拉他韦和阿昔洛韦进行不含干扰素的治疗。虽然第一天他出现了导管相关性菌血症，但无干扰素治疗安全地继续进行，立即导致他的肝功能改善。治疗4周后，他的胆红素水平从11.1 mg/dL降至2.1 mg/dL，血清丙型肝炎病毒RNA水平检测不到。这一病例表明，对伴有急性细胞排斥反应和细菌感染的进展性SCH患者进行非干扰素治疗是安全有效的，并可能改善丙型肝炎病毒阳性移植受体的预后。
Severe cholestatic hepatitis C (SCH) is a unique variant of recurrent hepatitis C that occurs after liver transplantation. Unfortunately, the prognosis of SCH is poor, and interferon (IFN) therapy has been reported to not improve the prognosis. We herein report a case of progressive SCH with acute cellular rejection (ACR) and bacterial infection, which was successfully treated using IFN‐free therapy with daclatasvir and asunaprevir. A 43‐year‐old man was diagnosed with SCH and mild ACR at day 48 after liver transplantation, and IFN‐free therapy with daclatasvir and asunaprevir was started. Although he experienced catheter‐related bacteremia on the first day, the IFN‐free therapy was safely continued, which immediately caused his liver function to improve. His bilirubin levels decreased from 11.1 to 2.1 mg/dL and serum hepatitis C virus RNA levels became undetectable after 4 weeks of the treatment. This case indicates that IFN‐free therapy for progressive SCH with acute cellular rejection and bacterial infection is safe and effective, and may improve the outcomes of hepatitis C virus positive transplant recipients.