Treatment of recurrent hepatitis C in liver transplant recipients.
Treatment of recurrent hepatitis C in liver transplant recipients.
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DOI：
10.1016/s1542-3565(05)00709-3
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发表时间：
2005-10-01
期刊：
影响因子：
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通讯作者：
Terrault, Norah A
中科院分区：
文献类型：
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作者：
Terrault, Norah A
移植后丙肝病程加快，平均25%的患者在移植后5年内出现肝硬化。因此，丙型肝炎病毒（HCV）感染患者的5年和10年移植存活率明显低于未感染丙型肝炎病毒的患者。预防HCV复发和/或改变移植后疾病进展速度的治疗干预是可取的。多克隆HCV抗体形式的预防性治疗在预防HCV再感染方面并不有效，但一项研究表明，高剂量的治疗可能会改变早期疾病复发的严重程度。先发制人的抗病毒治疗效果一般，而且通常耐受性差。活体供体肝移植受者和移植前终末期肝病模型评分低的受者可能对先发制人治疗的耐受性最好。用干扰素和利巴韦林联合治疗复发性疾病一直是治疗的主要方法。与先发制人的治疗类似，耐受性降低，剂量减少频繁。在迄今为止的研究中，持续病毒学应答率低于45%。组织学和生化改善通常比病毒学反应更频繁。总的来说，移植受者的HCV疾病的治疗还有很多需要改进的地方，迫切需要新的HCV治疗方法。
The course of hepatitis C is accelerated after transplantation, with an average of 25% of patients developing cirrhosis within 5 years of transplantation. Consequently, the 5- and 10-year graft survival rates in hepatitis C virus (HCV)-infected patients are significantly lower than in HCV-uninfected patients. Therapeutic interventions to prevent HCV recurrence and/or alter the rate of disease progression after transplantation are desirable. Prophylactic therapy in the form of polyclonal HCV antibodies has not been effective at prevention of HCV re-infection, but one study suggests that higher-dose therapy may modify the severity of early disease recurrence. Pre-emptive antiviral therapy has modest efficacy and generally is poorly tolerated. Live donor liver transplant recipients and recipients with low model of end-stage liver disease scores pretransplantation may tolerate pre-emptive therapy best. The treatment of recurrent established disease with a combination of interferon and ribavirin has been the mainstay of management. Similar to pre-emptive therapy, tolerance is reduced and dose reductions are frequent. The sustained virologic response rates are less than 45% in studies to date. Histologic and biochemical improvements generally are more frequent than virologic responses. Overall, the treatment of HCV disease in transplant recipients leaves much to be desired and there is an urgent need of new HCV therapies in this patient population.