Advances in direct-acting antiviral therapy for liver transplant recipients with HCV-related hepatocellular carcinoma
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摘要: 直接抗病毒药物的上市使丙型肝炎的治疗取得了里程碑式进展,但其在HCV相关肝细胞癌(HCC)肝移植中应用的具体时机和有效性尚待进一步探讨。归纳了目前国内外相关的指南、共识及推荐意见,分别总结了不同治疗时机的优势,并针对直接抗病毒药物对移植后HCV相关HCC复发率的影响这一具有争议性的问题,作出了现有相关研究的回顾性分析,认为直接抗病毒药物治疗可以减少HCV相关HCC肝移植受者的肝癌复发风险。治疗时机的选择需综合考虑肝功能、移植等待时间、HCV阳性器官的利用等多方面因素。Abstract: The launch of direct-acting antiviral agents is a milestone in the treatment of hepatitis C, but further studies are needed to explore its specific timing and effectiveness in liver transplantation for HCV-related hepatocellular carcinoma (HCC). This article summarizes related guidelines, consensus statements, and recommendations in China and globally and the advantages of different treatment timing strategies. Furthermore, a retrospective analysis of related studies is performed to investigate the controversial topic of the impact of direct-acting antiviral agents on the recurrence rate of HCV-related HCC after liver transplantation, and it is pointed that direct-acting antiviral agents can reduce the risk of HCC recurrence in liver transplant recipients with HCV-related HCC. The selection of treatment timing should consider various factors such as liver function, waiting time for donors, and utilization of HCV-positive organs.
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Key words:
- Carcinoma, Hepatocellular /
- Hepacivirus /
- Liver Transplantation /
- Antiviral Agents
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表 1 HCV相关HCC的肝移植受者接受DAA治疗后HCC复发率
第一作者,年份 地区 研究类型 纳入人群(例) 治疗时间及分组 中位随访时间 DAA治疗时机 SVR率 肝癌复发率 Yang JD,2016 [18] 荷兰 回顾性 81 移植前DAA治疗18例移植前未治疗63例 NA 移植前 NA 27.8%(5/18) 移植前DAA治疗18例移植前未治疗63例 9.5%(6/63) ANRS,2016 [19] 法国 前瞻性 314(CO23 CUPILT队列) 70.3(70±64)个月 移植后 96.8%(12周) 2.2%(7/314) Zanetto A,2017 [20] 美国 回顾性 23 移植前DAA治疗9例 10(6~19)个月 移植前 NA 12.5%(1/8) 对照组14例 7(5~19)个月 移植后 NA 8.3%(1/12) Zanaga LP,2019 [21] 巴西 回顾性 36 DAA治疗 20个月(自DAA治疗) 移植后 100% 0(0/36) Bielen R,2017 [22] 比利时 回顾性 22 IFN+DAA治疗1例 NA NA NA 0(0/22) DAA治疗21例 Emamaullee JA,2019 [23] 加拿大 回顾性 25 移植前达到SVR 13例 >2年 NA 100%(25/25) 23.1%(3/13) 移植后达到SVR 12例 17.7%(2/12) Jain A,2019 [24] 美国 NA 47 DAA治疗且获得SVR 20例 (50.5±25.4)个月 NA 100%(20/20) 0(0/20) DAA治疗未获得SVR 5例 (50.5±25.4)个月 0(0/5) 60%(3/5) 未DAA治疗20例 (71.2±23.8)个月 NA 5%(1/20) Gorgen A,2020 [25] 加拿大 回顾性 875 移植前DAA治疗121例 2.1年 移植前 93.4%(113/121) 6.6%(8/121) 移植前IFN治疗112例 2.9年 移植前 33% (37/112) 15.2%(17/112) 未抗病毒治疗142例 2.7年 NA NA 28.2%(40/142) 移植后DAA治疗395例 4.5年 移植后 96.5%(381/395) 6.3%(25/395) 移植后IFN治疗105例 7.8年 移植后 67.6%(71/105) 11.4%(12/105) Adhoute X,2018 [26] 法国 回顾性 8 DAA治疗组3例 68(24~75)个月 移植后 NA 16.7%(1/3) 未DAA治疗组5例 32(25~69)个月 20.0%(1/5) 注: NA,原文中未描述。 -
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