直接抗病毒藥品治療C型肝炎期間接受腎臟移植之案例探討

Kidney Transplantation During Direct-Acting Antiviral Agent Therapy for Hepatitis C Infection: Case Report

施玉芬(Yu-Fen Shih) ； 黃千惠(Chien-Huei Huang) ； 林文亮(Wen-Liang Lin) ； 鄭靜蘭(Ching-Lan Cheng)

《臺灣臨床藥學雜誌》 28卷1期 (2020/01) Pp. 70-75

https://doi.org/10.6168/FJCP.202001_28(1).0009

摘要

直接抗病毒藥物（direct-acting antiviral agents, DAAs）是根治慢性C型肝炎的新銳藥品，然而在DAAs治療慢性C型肝炎期間是否能接受器官移植的資訊卻相當有限。因此，我們報告一例64歲男性，已接受elbasvir/grazoprevir治療慢性C型肝炎基因型1a約1個月，接受帶有C型肝炎病毒抗體之腦死捐贈腎臟，移植時C型肝炎病毒量＜ 15 IU/mL，經密集地監測tacrolimus血中濃度並謹慎地調整藥物劑量，不僅慢性C型肝炎完治並且達到持續病毒反應（sustained virologic response, SVR），同時腎功能也恢復良好。由此可見，此案例可作為使用DAAs治療C型肝炎有快速病毒反應者（rapid virolgic response, RVR），在接受腎臟移植手術後，不干擾移植腎預後之經驗。

關鍵字

直接抗病毒藥物 ； C型肝炎 ； tacrolimus ； 腎臟移植

並列摘要

Direct-acting antiviral agents (DAAs) are novel medications to eradicate hepatitis C virus (HCV) infection. However, information on transplantation during DAAs therapy is limited. We report a case who received kidney transplant during DAAs therapy for HCV infection. A 64-year-old man, who had been receiving elbasvir/grazoprevir for genotype 1a chronic HCV infection around one month and then matched a HCV antibody positive deceased brain death donor for kidney transplant. The recipient's HCV viral load was below 15 IU/mL at transplant day. With frequent monitoring of tacrolimus serum level and dosage adjustment carefully, the allograft function well and he completed DAAs treatment course and achieved a sustained virologic response without graft rejection. The case illustrated that a favorable prognosis could be gained on kidney transplantation in HCV infected patients who had rapid virologic response under DAAs therapy.

並列關鍵字

DAA ； HCV ； Tacrolimus ； Kidney Transplant