Longitudinal variation in hepatitis C virus (HCV) viraemia and early course of HCV infection after liver transplantation for HCV cirrhosis: the role of different immunosuppressive regimens

被引:52
作者
Papatheodoridis, GV
Barton, SGRG
Andrew, D
Clewley, G
Davies, S
Dhillon, AP
Dusheiko, G
Davidson, B
Rolles, K
Burroughs, AK
机构
[1] Royal Free Hosp, Liver Transplantat Unit, London NW3 2QG, England
[2] Royal Free Hosp, Dept Virol, London NW3 2QG, England
[3] Royal Free Hosp, Dept Histopathol, London NW3 2QG, England
关键词
HCV RNA; HCV genotype; grading score; staging score; immunosuppression; liver transplantation;
D O I
10.1136/gut.45.3.427
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background-The role of the type of immunosuppression in the natural history of post-transplant hepatitis C virus (HCV) infection is unclear, Aims-To evaluate the fluctuation of HCV viraemia and the early course of infection, and their relation to the type of immunosuppression in HCV transplant patients. Methods-In 47 HCV transplant patients, serum HCV RNA levels were determined pretransplant and at one and two weeks, and three and 12 months after transplant. Initial immunosuppression was triple (cyclosporin, azathioprine, prednisolone) in 31, double (cyclosporin, prednisolone) in five, and single (cyclosporin or tacrolimus) in 11 patients. Prednisolone was withdrawn at a median of six months. Results-At three months, HCV RNA levels were higher in patients with single than with triple or double initial therapy. At 12 months, HCV RNA levels correlated only with duration of prednisolone treatment and were relatively higher in patients with triple compared with single initial immunosuppression. A higher necroinflammatory activity at 12 months post-transplant was found in patients with post-transplant acute hepatitis compared with those without. Extent of fibrosis at 12 months was associated with the 12 month HCV RNA level and occurrence of post-transplant acute hepatitis. Conclusions-HCV RNA levels at three months after transplant are higher in patients treated with single initial immunosuppressive therapy, but at 12 months are higher in patients with longer duration of steroid treatment. HCV viraemia at 12 months seems to be particularly important, as its levels are strongly correlated with the severity of fibrosis.
引用
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页码:427 / 434
页数:8
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