Evidence that clearance of hepatitis C virus RNA after α-interferon therapy in dialysis patients is sustained after renal transplantation
Evidence that clearance of hepatitis C virus RNA after α-interferon therapy in dialysis patients is sustained after renal transplantation
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DOI：
10.1097/01.asn.0000079613.81511.3c
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发表时间：
2003-08-01
影响因子：
13.6
通讯作者：
Rostaing, L
中科院分区：
文献类型：
--
作者：
Kamar, N;Toupance, O;Rostaing, L
迄今为止，尚无针对肾移植（RT）后丙型肝炎病毒（HCV）感染的可用治疗方法。在接受 IFN-α（6 或 12 个月期间 9 MU/周）治疗的 55 名抗 HCV 阳性/HCV RNA 阳性血液透析患者中，其中 21 名 (38%) 出现持续病毒学应答。其中，16 例 (76%) 在 α-IFN 治疗后 38 个月（范围为 2 至 57 个月）接受了 RT。其中有 13 名男性和 3 名女性，年龄为 46 岁（范围为 27 岁至 68 岁）。放疗时，15 名患者的 HCV 血清学仍呈阳性，所有患者的 HCV 病毒血症均为阴性。免疫抑制依赖于抗钙调神经磷酸酶药物，有或没有类固醇和/或抗代谢药；此外，其中12人接受了抗胸腺细胞球蛋白诱导治疗。 RT 后最后一次随访时，即 22.5 个月（范围：2 至 88 个月），所有患者的 HCV 病毒血症均保持阴性。此外，在对 8 名患者进行评估时，外周血单核细胞中不存在 HCV RNA。 13名患者的HCV血清学检查仍呈阳性。三名患者出现急性排斥反应，一名患者出现化脓性淋巴囊肿，一名患者死于败血症，四名患者出现巨细胞病毒感染。他们中没有人患上移植后糖尿病。总之，等待 RT 的血液透析患者需要接受 α-IFN 治疗，因为当 HCV RNA 发生清除时，尽管进行长期免疫抑制治疗，但移植后他们不会出现复发。
To date, there is no available treatment of hepatitis C virus (HCV) infection after renal transplantation (RT). Among 55 anti-HCV-positive/HCV RNA-positive hemodialysis patients who were treated with IFN-alpha (9 MU/wk during 6 or 12 mo), 21 of them (38%) had a sustained virologic response. Of these, 16 (76%) underwent RT 38 mo (range, 2 to 57 mo) after alpha-IFN therapy. There were 13 men and 3 women aged 46 yr (range, 27 to 68 yr). At RT, HCV serology was still positive in 15 patients, and HCV viremia was negative in all patients. Immunosuppression relied on anticalcineurin agents with or without steroids and/or antimetabolites; in addition, 12 of them received induction therapy with antithymocyte globulins. At the last follow-up after RT, at 22.5 mo (range, 2 to 88 mo), HCV viremia remained negative in all patients. Moreover, HCV RNA was not present in peripheral blood mononuclear cells when assessed in eight patients. HCV serology was found to be still positive in 13 patients. Three patients presented with acute rejection, one presented with a suppurative lymphocele, one died from a sepsis, and four presented with a cytomegalovirus infection. None of them developed posttransplant diabetes mellitus. In conclusion, hemodialysis patients waiting for a RT need to be treated with alpha-IFN because when HCV RNA clearance occurred, they experienced no relapse after transplantation despite chronic immunosuppressive treatment.