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Quản lý nhiễm trùng HCV tái phát sau ghép gan | 85 Lợi ích mô học không đáp ứng virus học đã được chứng minh trong một nghiên cứu chỉ có 22% trong một nhóm được điều trị ưu tiên tiến so với 49% bệnh nhân không được điều trị "phòng ngừa" (Kuo 2008) | Management of recurrent HCV infection following liver transplantation 85 Histological benefits in virologic nonresponders have been demonstrated in a study where only 22 in a group receiving preemptive therapy progressed vs. 49 of patients not receiving preemptive therapy Kuo 2008 . However this prophylactic approach cannot be used in a considerable proportion of patients due to initially intense immunosuppression pancytopenia postoperative infections and insufficient recovery after the surgery. Therapy of recurrent hepatitis C after LT Posttransplant antiviral therapy in recipients with evidence of biochemical and histological recurrent disease usually 6 months after LT is the mainstay of management. Although a high number of transplant centers use antiviral therapy the treatment is not standardized and is still associated with low rates of SVR less than those reported in the non-transplant setting. The main reasons include high VL post-LT a higher frequency of genotype 1 patients poor tolerability of treatment after LT and need for frequent dose reductions. The combination of PegIFN RBV is the treatment of choice also in transplant recipients. The SVR associated with PegIFN RBV therapy in predominantly genotype 1 infected populations has been reported to range from 12 to as high as 50 Gonzalez 2010 . A recent extensive review of 19 prospective and retrospective clinical studies describing antiviral therapy with PegIFN RBV in this population reported a mean SVR of 30.2 Berenguer 2008 . End of treatment virologic response EoTR was 42.2 range 17-68 indicating that relapse was a major factor in the low SVR rates. Biochemical responses were registered in 54.8 and histological endpoints were judged to be too heterogeneous in definition and assessment to provide a summary estimate. However it was noted that histological improvements were generally confined to treated patients who achieve SVR. Fibrosis has been shown to progress significantly more in nonresponders to .
