vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2021-1-15-23vtio-1310Research ArticleТРАНСПЛАНТАЦИЯ ОРГАНОВORGAN TRANSPLANTATIONРезультаты трансплантации печени в эпоху современной противовирусной терапии гепатита СOutcomes of liver transplantation in the era of modern antiviral therapy for hepatitis CКокинаК. Ю.KokinaK. Yu.

Кокина Ксения Юрьевна.

129110, Москва, ул. Щепкина, 61/2.

Тел. (985) 814-36-34

Kseniia Kokina.

61/1, Shchepkina str., Moscow, 129110.

Phone: (985) 814-36-34

kseniaur@yandex.ruМалиновскаяЮ. О.MalinovskayaYu. O.

129110, Москва, ул. Щепкина, 61/2.

61/1, Shchepkina str., Moscow, 129110.

МойсюкЯ. Г.MoysyukYa. G.

129110, Москва, ул. Щепкина, 61/2.

61/1, Shchepkina str., Moscow, 129110.

Московский областной научно-исследовательский клинический институт имени М.Ф. ВладимирскогоРоссияVladimirsky Moscow Regional Research Clinical InstituteRussian Federation2021100420212311523Copyright © Кокина К.Ю., Малиновская Ю.О., Мойсюк Я.Г., 20212021Кокина К.Ю., Малиновская Ю.О., Мойсюк Я.Г.Kokina K.Y., Malinovskaya Y.O., Moysyuk Y.G.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/1310

Появление препаратов прямого противовирусного действия (ПППД) стало основой для формирования нового потенциала для лечения хронического гепатита С (ХГС) у больных с декомпенсированным циррозом печени, которые ранее не имели иной альтернативы, как трансплантация печени (ТП). Однако открытым остается вопрос оптимальных сроков проведения противовирусной терапии (ПВТ). Цель: представить спектр клинических исходов у пациентов с циррозом печени HCV-этиологии, получавших ПВТ ПППД и без нее, в листе ожидания ТП. Материалы и методы. Для исследования было отобрано 49 пациентов из листа ожидания с терминальной стадией заболевания печени в исходе ХГС. Данные были разделены на 2 группы: 1-я включала 40 пациентов, получавших ПВТ ПППД до ТП, 2-я - 9 пациентов без противовирусного лечения в листе ожидания ТП. Результаты. Выборка представлена в большинстве случаев пациентами с MELD-Na <20 баллов, и лишь у шести MELD-Na был больше 20 баллов, но не превышал 25 баллов. На момент анализа 38 пациентов достигли срока 12 недель после ПВТ. Из них у 35 (92,1%) зарегистрирован устойчивый вирусологический ответ (УВО). Из них в 51,4% (n = 18) случаев наблюдалось снижение MELD-Na. Изменения отсутствовали в 22,9% (n = 8), в то время как у 25,7% (n = 9) отмечено нарастание MELD-Na. В 42,8% (n = 15) случаев стойкая элиминация HCV-инфекции привела к делистингу. Среди пациентов без УВО во всех случаях (n = 3) зарегистрировано увеличение показателя MELD-Na. В группе без ПВТ у одного пациента наблюдалось улучшение функции печени (11,1%), у остальных MELD-Na либо оставался стабильным, либо продолжал расти: такие случаи составили равные доли по 44,5% (n = 4). При сравнении частоты летального исхода в зависимости от проведения ПВТ были получены статистически значимые различия (p < 0,001, V = 0,728). При отсутствии ПВТ шансы погибнуть в листе ожидания увеличивались в 66,5 раза (95% ДИ: 7 ,99-554). Заключение. Результаты нашего исследования продемонстрировали значимые преимущества проведения ПВТ ПППД для пациентов в листе ожидания с уровнем MELD-Na <25 баллов.

The emergence of direct-acting antivirals (DAAs) has become the basis for a new potential treatment for chronic hepatitis C (CHC) in patients with decompensated cirrhosis, who previously had no other alternative than liver transplantation (LT). However, optimal timing of antiviral therapy (AVT) remains an issue. Objective: to present a spectrum of clinical outcomes in LT waitlisted patients with HCV-related cirrhosis, who received and did not receive DAA therapy. Materials and methods. Enrolled for the study were 49 waitlisted patients with HCV-related end-stage liver diseases. The patients were divided into 2 groups: Group 1 included 40 patients who received DAA therapy before LT, while Group 2 consisted of 9 patients who did not receive antiviral treatment while on the LT waiting list. Results. The sample was represented in most cases by patients who had MELD/Na score <20. Only six had MELD/Na score >20, but <25. At the time of analysis, 38 patients had reached 12 weeks post AVT. Of these, 35 (92.1%) had sustained virologic response (SVR). Of these, 51.4% (n = 18) of cases showed decreased MELD/Na. There were no changes in 22.9% (n = 8). Increased MELD/Na was noted in 25.7% (n = 9). In 42.8% (n = 15) of cases, sustained elimination of HCV infection led to delisting. Among patients without SVR, increased MELD/Na was observed in all cases (n = 3). In the non-AVT group, one patient showed improved liver function (11.1%); in the rest, MELD/Na either remained stable or continued to increase - 44.5% (n = 4). A comparison of the frequency of deaths depending on AVT showed statistically significant differences (p < 0.001, V = 0.728). Among the non-AVT patients, the likelihood of waitlist death increased 66.5 times (95% CI: 7.99-554). Conclusion: DAA therapy carries significant advantages for waitlisted patients with MELD/Na score <25.

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The authors declare that there are no conflicts of interest present.