Survival benefits of interferon-based therapy in patients with recurrent hepatitis C after orthotopic liver transplantation

Recurrent hepatitis C after orthotopic liver transplantation (OLT) is universal and can lead to graft failure and, consequently, reduced survival. Hepatitis C treatment can be used to prevent these detrimental outcomes. The aim of this study was to describe rates of hepatitis C recurrence and sustained virological response (SVR) to interferon-based treatment after OLT and its relationship to survival and progression of liver disease through retrospective analysis of medical records of 127 patients who underwent OLT due to cirrhosis or hepatocellular carcinoma secondary to chronic hepatitis C between January 2002 and December 2013. Fifty-six patients were diagnosed with recurrent disease, 42 started interferon-based therapy and 37 completed treatment. Demographic, treatment- and outcome-related variables were compared between SVR and non-responders (non-SVR). There was an overall 54.1% SVR rate with interferon-based therapies. SVR was associated with longer follow-up after treatment (median 66.5 vs 37 months for non-SVR, P=0.03) and after OLT (median 105 vs 72 months, P=0.074), and lower rates of disease progression (15 vs 64.7%, P=0.0028) and death (5 vs 35.3%, P=0.033). Regardless of the result of therapy (SVR or non-SVR), there was a significant difference between treated and untreated patients regarding the occurrence of death (P<0.001) and months of survival (P<0.001). Even with suboptimal interferon-based therapies (compared to the new direct-acting antivirals) there is a 54.1% SVR rate to treatment. SVR is associated with improved survival and reduced risks of clinical decompensation, loss of the liver graft and death.

原位肝移植（orthotopic liver transplantation, OLT）后复发性丙型肝炎普遍存在，可引发移植肝失功，进而降低患者总体生存率。针对丙型肝炎的治疗可有效预防上述不良临床结局。本研究通过回顾性分析2002年1月至2013年12月间127例因慢性丙型肝炎继发肝硬化或肝细胞癌接受原位肝移植患者的病历资料，旨在阐明原位肝移植术后丙型肝炎复发率、基于干扰素治疗的持续病毒学应答（sustained virological response, SVR）率，以及该应答与患者生存状况及肝病进展的关联。本研究纳入的127例患者中，56例被确诊为复发性丙型肝炎，42例启动基于干扰素的抗病毒治疗，37例完成全部治疗疗程。研究对比了持续病毒学应答者（SVR组）与无应答者（非SVR组）的人口学特征、治疗相关变量及临床结局相关变量。结果显示，基于干扰素的治疗整体持续病毒学应答率为54.1%。SVR与治疗后更长的随访时长（中位随访时长66.5个月 vs 非SVR组的37个月，P=0.03）及原位肝移植术后更长的随访时长（中位随访时长105个月 vs 72个月，P=0.074）显著相关，同时患者疾病进展率更低（15% vs 64.7%，P=0.0028）、死亡率更低（5% vs 35.3%，P=0.033）。无论治疗结局为SVR还是非SVR，接受治疗的患者与未接受治疗的患者在死亡发生率（P<0.001）及中位生存月数（P<0.001）方面均存在显著差异。尽管基于干扰素的治疗方案疗效不及新型直接抗病毒药物（direct-acting antivirals, DAAs），但其持续病毒学应答率仍可达54.1%。持续病毒学应答（SVR）与患者生存率提升、临床失代偿风险降低、移植肝丢失及死亡风险降低密切相关。