Interleukin-2 receptor antagonist immunosuppression and consecutive viral management in living-donor liver transplantation for human immunodeficiency virus/hepatitis C-co-infected patients: a report of 2 cases
Interleukin-2 receptor antagonist immunosuppression and consecutive viral management in living-donor liver transplantation for human immunodeficiency virus/hepatitis C-co-infected patients: a report of 2 cases
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白细胞介素2受体拮抗剂免疫抑制和连续病毒治疗在人类免疫缺陷病毒/丙型肝炎合并感染患者活体肝移植中的应用：附2例报告
DOI：
10.1007/s12328-015-0621-8
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Norihiro Kokudo
中科院分区：
文献类型：
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作者：
Harufumi Maki;Junichi Kaneko;Satoshi Yamamoto;Nobuhisa Akamatsu;Junichi Arita;Yoshihiro Sakamoto;Kiyoshi Hasegawa;Tomohiro Tanaka;Sumihito Tamura;Yasuhiko Sugawara;Kunihisa Tsukada;Norihiro Kokudo
活体肝移植（LDLT）中人类免疫缺陷病毒/丙型肝炎（HIV/HCV）的免疫抑制管理尚未建立。我们对两例HIV/ hcv合并感染的终末期肝病患者进行了LDLT。免疫抑制方案包括早期无钙调磷酸酶抑制剂和白细胞介素-2受体拮抗剂（IL2Ra）诱导和甲基强的松龙。开始维持低剂量他克莫司，并在LDLT后1周重新开始抗逆转录病毒治疗。随后，成功加入聚乙二醇干扰素和利巴韦林治疗，作为HCV的先发制人治疗。在肝功能正常的LDLT后17个月和8个月，抗逆转录病毒治疗和HCV治疗分别检测不到HIV-RNA和HCV- rna。该研究首次报道了早期无钙调磷酸酶抑制剂和il - 2ra诱导甲基强的松龙免疫抑制LDLT治疗HIV/ hcv合并感染患者的良好结果。连续的HIV/HCV治疗耐受性良好。
Management of immunosuppression for human immunodeficiency virus/hepatitis C (HIV/HCV) in living-donor liver transplantation (LDLT) has not been established. We performed LDLT for two patients with HIV/HCV-co-infected end-stage liver disease. The immunosuppression protocol consisted of early calcineurin inhibitor-free and interleukin-2 receptor antagonist (IL2Ra) induction and methylprednisolone. Maintenance low-dose tacrolimus was started and anti-retroviral therapy for HIV was re-started 1 week after LDLT. Consecutively, pegylated interferon and ribavirin therapy were successfully added as pre-emptive therapy for HCV. HIV-RNA and HCV-RNA were undetectable on anti-retroviral therapy and HCV treatment at 17 and 8 months after LDLT, respectively, with normal liver function. This study is the first report of early calcineurin inhibitor-free and IL2Ra induction with methylprednisolone immunosuppression in LDLT for HIV/HCV-co-infected patients with a favorable outcome. Consecutive HIV/HCV treatment was well tolerated.