SECTION 13. SHORT-COURSE PRETRANSPLANT ANTIVIRAL THERAPY IS A FEASIBLE AND EFFECTIVE STRATEGY TO PREVENT HEPATITIS C RECURRENCE AFTER LIVER TRANSPLANTATION IN GENOTYPE 2 PATIENTS

被引:3
作者
Lin, Chih-Che [1 ,2 ,3 ]
Kabiling, Catherine [1 ,2 ,3 ]
Chen, Chao-Long [1 ,2 ,3 ]
Lin, Yu-Hung [1 ,2 ,3 ]
Liu, Yueh-Wei [1 ,2 ,3 ]
Wang, Chih-Chi [1 ,2 ,3 ]
Hu, Tsung-Hui [4 ]
Chiu, King-Wah [4 ]
机构
[1] Kaohsiung Chang Gung Mem Hosp, Liver Transplantat Program, Kaohsiung 833, Taiwan
[2] Kaohsiung Chang Gung Mem Hosp, Dept Surg, Kaohsiung 833, Taiwan
[3] Chang Gung Univ, Coll Med, Kaohsiung, Taiwan
[4] Chang Gung Univ, Kaohsiung Chang Gung Mem Hosp, Dept Internal Med, Div Hepatogastroenterol,Coll Med, Kaohsiung, Taiwan
关键词
Liver transplantation; Hepatitis C; Genotype; Antiviral; WAITING-LIST; VIRUS; INFECTION; RIBAVIRIN; CIRRHOSIS; TRIAL;
D O I
10.1097/01.tp.0000446277.36181.e7
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. Hepatitis C virus (HCV) recurrence in recipients who are viremic at time of liver transplantation (LT) is universal and carries poor prognosis. Pretransplant antiviral therapy to eradicate HCV reduces recurrence, but withdrawal rate is high. We conducted a short-course (4 weeks) of pegylated interferon alpha-2a (Peg-IFN-alpha 2a) plus ribavirin (RBV) to prevent of HCV recurrence. Patients and Methods. From October 2009 to December 2011, eighty-eight consecutive HCV patients for living donor LT with potential living donor at Kaohsiung Chang Gung Memorial Hospital were included. Patients were divided into treatment and nontreatment group depending on presence of HCV-RNA. Fixed dosage of Peg-IFN-alpha 2a (135 mu g/week) plus RBV (10 mg/kg per day) were given for 4 weeks to treatment group who passed the 4-week waiting time according to clinical safety assessment. Results. Forty-eight patients with genotypes 1, 2, and 3 (n=29/18/1) were treated with IFN and RBV combination for 4 (range, 1-9) weeks. Serum HCV RNA became undetectable at transplantation in 26 (54%) patients. No difference between genotypes 1 (n=14, 48%) and 2/3(n=12, 63%, P=0.25) was observed. Most patients experienced cytopenia during treatment, but no mortality was noted. In the treatment group, 13 patients remained free of HCV infection 6 months after transplant. Virologic response at transplantation (48% vs. 100%, P=0.015) and genotype 2/3 (50% vs. 84%, P=0.01) are strong predictors of lower HCV recurrence rate. Multivariate analysis showed that genotype 2/3 was the only independent predictive factor affecting HCV RNA negativity 6 months after liver transplantation (OR: 11.25; P=0.014). Conclusions. Short-term pretransplant antiviral therapy is a feasible strategy in preventing HCV recurrence after LDLT especially in genotypes 2 and 3 recipients.
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收藏
页码:S47 / S53
页数:8
相关论文
共 19 条
[1]   HCV-related fibrosis progression following liver transplantation:: increase in recent years [J].
Berenguer, M ;
Ferrell, L ;
Watson, J ;
Prieto, M ;
Kim, M ;
Rayón, M ;
Córdoba, J ;
Herola, A ;
Ascher, N ;
Mir, J ;
Berenguer, J ;
Wright, TL .
JOURNAL OF HEPATOLOGY, 2000, 32 (04) :673-684
[2]   A pilot study of the tolerability and efficacy of antiviral therapy in hepatitis C virus-infected patients awaiting liver transplantation [J].
Crippin, JS ;
McCashland, T ;
Terrault, N ;
Sheiner, P ;
Charlton, MR .
LIVER TRANSPLANTATION, 2002, 8 (04) :350-355
[3]   A Randomized Controlled Trial of Pretransplant Antiviral Therapy to Prevent Recurrence of Hepatitis C After Liver Transplantation [J].
Everson, Gregory T. ;
Terrault, Norah A. ;
Lok, Anna S. ;
Rodrigo, Del R. ;
Brown, Robert S., Jr. ;
Saab, Sammy ;
Shiffman, Mitchell L. ;
Al-Osaimi, Abdullah M. S. ;
Kulik, Laura M. ;
Gillespie, Brenda W. ;
Everhart, James E. .
HEPATOLOGY, 2013, 57 (05) :1752-1762
[4]   Treatment of patients with hepatitis C virus on the waiting list [J].
Everson, GT .
LIVER TRANSPLANTATION, 2003, 9 (11) :S90-S94
[5]   Should we treat patients with chronic hepatitis C on the waiting list? [J].
Everson, GT .
JOURNAL OF HEPATOLOGY, 2005, 42 (04) :456-462
[6]   Treatment of advanced hepatitis C with a low accelerating dosage regimen of antiviral therapy [J].
Everson, GT ;
Trotter, J ;
Forman, L ;
Kugelmas, M ;
Halprin, A ;
Fey, B ;
Ray, C .
HEPATOLOGY, 2005, 42 (02) :255-262
[7]   Predicting sustained virological responses in chronic hepatitis C patients treated with peginterferon alfa-2a (40 KD)/ribavirin [J].
Ferenci, P ;
Fried, MW ;
Shiffman, ML ;
Smith, CI ;
Marinos, G ;
Gonçales, FL ;
Häussinger, D ;
Diago, M ;
Carosi, G ;
Dhumeaux, D ;
Craxì, A ;
Chaneac, M ;
Reddy, KR .
JOURNAL OF HEPATOLOGY, 2005, 43 (03) :425-433
[8]   Antiviral therapy of patients with decompensated cirrhosis to prevent recurrence of hepatitis C after liver transplantation [J].
Forns, X ;
García-Retortillo, M ;
Serrano, T ;
Feliu, A ;
Suarez, F ;
de la Mata, M ;
García-Valdecasas, JC ;
Navasa, M ;
Rimola, A ;
Rodés, J .
JOURNAL OF HEPATOLOGY, 2003, 39 (03) :389-396
[9]   Hepatitis C virus kinetics during and immediately after liver transplantation [J].
Garcia-Retortillo, M ;
Forns, X ;
Feliu, A ;
Moitinho, E ;
Costa, J ;
Navasa, M ;
Rimola, A ;
Rodes, J .
HEPATOLOGY, 2002, 35 (03) :680-687
[10]   Long-term outcome of liver transplants for chronic hepatitis C: A 10-year follow-up [J].
Neumann, UP ;
Berg, T ;
Bahra, M ;
Puhl, G ;
Guckelberger, O ;
Langrehr, JM ;
Neuhaus, P .
TRANSPLANTATION, 2004, 77 (02) :226-231