Strategies to treat interferon-induced graft dysfunction after living donor liver transplantation for hepatitis C

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• 作者：Toru Ikegami (1)
  Huanlin Wang (2)
  Tomoharu Yoshizumi (1)
  Takeo Toshima (1)
  Shinichi Aishima (2)
  Takasuke Fukuhara (1)
  Norihiro Furusyo (3)
  Kazuhiro Kotoh (4)
  Shinji Shimoda (5)
  Ken Shirabe (1)
  Yoshihiko Maehara (1)
  
• 关键词：Hepatitis C ; Interferon ; Liver transplantation ; Autoimmune hepatitis ; Rejection
• 刊名：Hepatology International
• 出版年：2014
• 出版时间：April 2014
• 年：2014
• 卷：8
• 期：2
• 页码：285-292
• 全文大小：2,047 KB
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• 作者单位：Toru Ikegami (1)
  Huanlin Wang (2)
  Tomoharu Yoshizumi (1)
  Takeo Toshima (1)
  Shinichi Aishima (2)
  Takasuke Fukuhara (1)
  Norihiro Furusyo (3)
  Kazuhiro Kotoh (4)
  Shinji Shimoda (5)
  Ken Shirabe (1)
  Yoshihiko Maehara (1)
  
  1. Department of Surgery and Science, Graduate School of Medical Science, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
  2. Department of Anatomic Pathology, Graduate School of Medical Science, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
  3. General Internal Medicine, Graduate School of Medical Science, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
  4. Medicine and Bioregulatory Science and Medicine and Biosystemic Science, Graduate School of Medical Science, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
  5. Medicine and Biosystemic Science, Graduate School of Medical Science, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
  
• ISSN：1936-0541

文摘

Purpose Interferon-induced graft dysfunction (IGD) is a poorly defined, unrecognized, but potentially serious condition for patients receiving antiviral drugs after liver transplantation for hepatitis C. Methods We evaluated the characteristics of 80 patients who received pegylated interferon-based antiviral treatment for hepatitis C after living donor liver transplantation (LDLT). Results Eight patients experienced IGD either during (n?=?6) or after completing (n?=?2) antiviral treatment. Pathological diagnosis included acute cellular rejection (ACR, n?=?1), plasma cell hepatitis (PCH, n?=?2), PCH plus ACR (n?=?3), and chronic rejection (CR, n?=?2). One patient with CR initially presented with PCH plus ACR and the other presented with ACR; both had apparent cholestasis. The six patients with ACR or PCH without cholestasis were successfully treated by discontinuing antiviral treatment and increasing immunosuppression, including steroids. By contrast, both of the patients with CR and cholestasis experienced graft loss, despite aggressive treatment. Univariate analysis showed that pegylated interferon-α2a-based treatment (75 vs. 26.4?%, p?<?0.01) was the only significant factor for IGD, and was associated with decreased 5-year graft survival (93.4 vs. 71.4?%, p?=?0.04). Conclusions IGD is a serious condition during or even after antiviral treatment for hepatitis C after LDLT. Early recognition, diagnosis, discontinuation of interferon, and introduction of steroid-based treatment may help to save the graft.