实用器官移植电子杂志

实用器官移植电子杂志 ›› 2020, Vol. 8 ›› Issue (2): 96-100.DOI: 10.3969/j.issn.2095-5332.2020.02.005

• 论著 • 上一篇    下一篇

直接抗病毒药物在肾移植丙型肝炎病毒患者中的应用

冯成 1 ，杨洪吉 1，2，3，侯一夫 2 ，冉清 2 ，狄文佳 2 ，钟山 2 ，王筱啸 2
  

  1. 1. 西南医科大学临 床医学院，四川 泸州 646000 ；

    2. 电子科技大学附属医院，四川省人民医院器官移植 中心，四川 成都 610072 ；

    3. 四川省医学科学院，四川省人民医院临床免疫转化医学 四川省重点实验室，四川 成都 611713

  • 出版日期:2020-03-20 发布日期:2021-06-02

Application of direct antiviral drugs in patients with hepatitis C virus after renal transplantation

Feng Cheng 1 ，Yang Hongji 1，2，3 ，Hou Yifu 2 ，Ran Qing 2 ，Di Wenjia 2 ，Zhong Shan 2 ，Wang Xiaoxiao 2 . 1   

  1. 1.Southwest Medical University Clinical Medicine College，Luzhou 646000，Sichuan，China ；

    2.Center of Organ Transplantation，Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital，School of Medicine，University of Electronic Science and Technology of China，Chengdu 610072，Sichuan，China ；

    3.Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province，Sichuan Provincial People's Hospital，University of Electronic Science and Technology of China，Chengdu 611731，Sichuan，Chin

  • Online:2020-03-20 Published:2021-06-02

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摘要：

目的 评估终末期肾病丙型肝炎病毒（hepatitis C virus，HCV）患者接受肾移植手术、接受 HCV IgG 抗体（+）供肾及 HCV 感染供肾患者术后使用直接抗病毒药物（direct antiviral drugs，DAAs）的安 全性及有效性。方法 回顾性纳入 12 例患者，其中 9 例为感染 HCV 接受肾移植手术的患者，1 例为接受 HCV IgG（+）供肾且术后口服索非布韦 + 维帕他韦抗病毒治疗，2 例为接受 6 a 型 HCV 感染供肾的患者， 术后口服索非布韦 + 维帕他韦抗病毒治疗。所有患者治疗期间定期复查血转氨酶、血清肌酐、药物浓度及 HCV RNA 复制量等相关数据来评估 DAAs 的疗效和安全性。结果 HCV 感染患者接受肾移植手术后均获得 持续性病毒学应答（sustained virological response，SVR），接受 HCV IgG 抗体（+）供肾患者术后 HCV RNA 及 HCV IgG 未出现阳性表达，接受 HCV 感染肾脏患者，术后复查提示 HCV IgG 阳性表达，截至随访至 12周，HCV RNA持续阴性。除1例患者治疗期间出现肺部感染，其余患者随访期间血肌酐、药物浓度水平稳定， 转氨酶水平较治疗前下降，1 例患者不良反应为头晕。结论 丙肝患者接受肾移植手术后使用 DAAs 在严 密检测下是安全可靠的，本文结果显示在有效的抗病毒治疗前提下接受 HCV IgG（+）供肾及 HCV 感染供 肾可能是安全的。

关键词: 肾移植 , 慢性丙型肝炎 , 直接抗病毒治疗 , 病毒学应答 , 疗效 , 安全性

Abstract:

Objective To assess the safety and effectiveness of direct antiviral drugs（DAAs）in hepatitis C virus（HCV）infected patients who underwent kidney transplantation with HCV IgG antibodies positive and HCV infected kidney grafts. Methods A tobal number of 12 patients were retrospectively enrolled，9 patients with HCV underwent kidney transplantation. 1 patient received HCV IgG positive kidney and oral sofobuvir plus vertapavir antiviral therapy，2 patients received kidneys infected with type 6 a HCV，oral anti-viral treatment with sofosbuvir plus vertapavir was given. All patients were regularly reviewed for trough concentration of immunosuppressiveagents in the blood，serum transaminase levels，creatinine level and serum HCV RNA level to assess the efficacy and safety of DAAs treatment. Results Patients with HCV infection achieved a sustained virological response （SVR）after kidney transplantation. Patients receiving HCV IgG antibody positive kidney had negative expression of HCV RNA and HCV IgG. Postoperative review showed positive expression of HCV IgG，HCV RNA continued to be negative during 12 weeks follow-up time in patients who received HCV-infected kidneys. In addition to pulmonary infection in one patient during treatment，the remaining patients had stable creatinine level and blood concentration of immunosuppressive agents，and serum transaminase levels were lower than before treatment during follow-up， the adverse effect was dizziness in 1 case. Conclusion Under close supervision，patients with hepatitis C were safe and reliable to use DAAs after renal transplantation. It is safe to use HCV IgG positive kidney and HCV infected kidney as donor grafts under the premise of effective antiviral therapy.

Key words: Kidney transplantation , Chronic hepatitis C , Direct-acting antiviral agents , Virological response, Efficacy, Safety

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