HCV相关肝硬化患者肝移植术后的抗病毒与免疫调节治疗

Features of HCV recurrence in patients with HCV- related cirrhosis after liver transplantation and its antiviral and immunomodulatory therapies

HCV相关肝硬化发生肝功能失代偿后的最佳选择可能是肝移植。移植后免疫调节药物尤其是免疫抑制剂的应用可能是加速HCV复发的一个主要因素,如何在减轻移植排斥反应的同时兼顾HCV感染的控制是目前须要探讨的问题。总结了目前HCV相关肝移植术后的抗病毒及免疫调节治疗情况,分析表明,在HCV相关肝硬化肝移植术后进行合理的免疫抑制和抗病毒治疗对于预防HCV复发、延长移植物生存期、改善患者预后具有至关重要的作用,突然改变免疫抑制方案,如快速撤药或改变免疫抑制剂的剂量或类型都有可能导致HCV的复发,类固醇激素缓慢进行性减量和硫唑嘌呤维持治疗也许有益。

The best choice of treatment for patients with HCV - related cirrhosis may be liver transplantation once liver decompensation oc- curs. Immunoregulatory drugs, especially immunosuppressants, may be a main causative factor for accelerated HCV recurrence after liver transplantation. How to control HCV infection while reducing graft rejection is a meaningful problem that needs to be solved. The current an- tiviral and immunomodulatory therapies after HCV - related liver transplantation are summarized. Analysis showed that proper immunosup- pression and antiviral therapy in patients with HCV - related cirrhosis after liver transplantation are of great significance for preventing HCV recurrence, prolonging graft survival, and improving prognosis. Sudden change in immunosuppressive therapy, such as rapid withdrawal or changing the dose or type of immunosuppressant, may lead to HCV recurrence. Slow progressive reduction in steroid hormone and mainte- nance treatment with azathioprine may be beneficial.