REDUCTION OF HCV RECURRANCE AFTER LIVER TRANSPLANTATION

背景：丙型肝炎病毒继发的终末期肝病 感染是原位肝移植的主要适应症 (OLT)在美国。丙型肝炎病毒感染的复发几乎 普遍存在，10%的丙型肝炎病毒感染受者经历了早期移植 继发于复发性丙型肝炎的损失或死亡。《国家报》 糖尿病和消化及肾脏疾病研究所肝脏 移植数据库(LTD)最近证明，Pre- 用丙型肝炎病毒核糖核酸测定的OLT病毒载量可以预测患者和 移植物存活率。目前尚不清楚降低原位肝移植前病毒载量是否会 提高病毒学复发率或患者或移植物存活率 丙型肝炎病毒感染的受者接受原位肝移植。 目的：为多中心的设计提供规划拨款， 加入干扰素的双盲随机对照试验- α(干扰素-α)和利巴韦林将由国家 糖尿病与消化和肾脏疾病研究所肝脏 联合三个额外肝脏的移植数据库 移植中心。为了设计这样一项研究，具体目标是 规划拨款建议的内容是：1)确定最佳研究规模 和持续时间(功率计算、分层策略) 目前丙型肝炎病毒感染者的病毒学特征 在参与中心等待肝移植，以及2)至 测定两种剂型干扰素的耐受性和疗效 利巴韦林用于丙型肝炎继发的终末期肝病患者。 方法：在参与中心等待肝移植的丙型肝炎病毒感染者 (纽约西奈山医疗中心梅奥诊所和基金会， 加州大学旧金山分校、加州大学旧金山分校 匹兹堡、内布拉斯加大学和贝勒大学医学院 中心)将被邀请参与研究。60人参加 将被随机分为单独接受非聚乙二醇化干扰素-α，非-聚乙二醇化干扰素-α 聚乙二醇化的干扰素-α利巴韦林或聚乙二醇化的干扰素-α利巴韦林。 统计分析将由公共研究生院进行 匹兹堡大学的健康。 意义：规划阶段的结果将有助于 多中心双盲、随机、 联合干扰素-α和利巴韦林的对照试验 降低原位肝移植前丙型肝炎病毒RNA滴度对移植后预后的影响 包括丙型肝炎复发。

Background: End-stage liver disease secondary to hepatitis C virus (HCV) infection is the leading indication for orthotopic liver transplantation (OLT) in the United States. Recurrence of HCV infection is nearly universal, with 10 of HCV-infected recipients experiencing early graft loss or death secondary to recurrent HCV disease. The National Institutes of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database (LTD) has recently demonstrated that the pre- OLT viral load, as measured by HCV RNA, is predictive of patient and graft survival. It is not known whether lowering pre-OLT viral load will improve the rate of virological recurrence, or patient or graft survival following OLT in HCV-infected recipients. Aims: A planning grant is proposed for the design of a multi-center, double-blind, randomized, controlled trial incorporating interferon- alpha (IFN-alpha) and ribavirin to be conducted by the National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database in conjunction with three additional Liver Transplant Centers. In order to design such a study, the specific aims of the planning grant proposal are: 1) to establish optimal study size and duration (power calculations, stratification strategy) through the virological characterization of the HCV-infected patients currently awaiting liver transplantation at the participating centers and 2) to determine the tolerability and efficacy of two forms of IFN-alpha and ribavirin in patients with end-stage liver disease secondary to HCV. Methods: HCV-infected patients awaiting OLT at the participating centers (the Mayo Clinic and Foundation, Mount Sinai Medical Center, New York, the University of California San Francisco, the University of Pittsburgh, the University of Nebraska and Baylor University Medical Center) will be invited to participate in the study. Sixty participants will be randomized to receive either non-pegylated IFN-alpha alone, non- pegylated IFN-alpha + ribavirin or pegylated IFN-alpha + ribavirin. Statistical analysis will be performed by the Graduate School of Public Health at the University of Pittsburgh. Significance: The results of the planning phase will facilitate the design and coordination of the multi-center double-blind, randomized, controlled trial incorporating IFN-alpha and ribavirin to determine the effect of lowering pre-OLT HCV RNA titers on posttransplant outcomes, including HCV recurrence.