Management of hepatitis C virus infection in the setting of liver transplantation

被引:39
|
作者
Rodriguez-Luna, H
Vargas, HE
机构
[1] Mayo Clin Hosp, Div Transplantat Med, Phoenix, AZ 85259 USA
[2] Mayo Clin, Div Transplantat, Scottsdale, AZ USA
关键词
D O I
10.1002/lt.20424
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
1. Posttransplantation recurrence of hepatitis C virus infection is a universal phenomenon with a highly variable natural history. 2. Approximately 10% to 25% of hepatitis C virus-infected recipients of liver allografts will develop cirrhosis within 5 years' after transplantation. 3. The 1-year actuarial risk of hepatic decompensation after recurrence of cirrhosis approximates 42%. 4. Some of the factors associated with aggressive recurrence include donor and recipient age, recent year of transplantation, recipient gender and race, the use of anti-thymocyte globulin, and high dose of corticosteroids. 5. Highly aggressive recurrent hepatitis C virus infection leading to cirrhosis fares poorly after retransplantation in the presence of hyperbilirubinemia and renal failure, with a 1-year survival of approximately 40%. 6. Elevated serum aminotransferases are a poor indicator or recurrent disease. 7. Current sustained virological response after combination pegylated alpha interferon and ribavirin treatment is approximately 25%. 8. There is no consensus on initiation time point, duration of treatment, or dosage. Given immunosuppression, at least 48 weeks of therapy is a reasonable approach. 9. Treatment for 48 weeks is cost effective. Incremental cost-effectiveness ratio for men aged 55 years is $29,100 per life-year saved.
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收藏
页码:479 / 489
页数:11
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