생체 부분간이식 수술 후 C형간염의 임상 양상
Clinical Outcome after Living Donor Liver Transplantation in Patients with Hepatitis C Virus-associated Cirrhosis
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배경/목적: C형간염에 의한 간경변증은 서구에서 간이식 수술의 가장 흔한 적응증 중 하나이고 국내에서도 증가 추세에 있다. 하지만 이식 후 초기부터 높은 C형간염의 재발률 때문에 환자와 이식편의 생존율은 불량하다고 알려져 있다. 이 연구에서는 C형간염 환자들의 생체 부분간이식 수술 이후의 재발의 빈도와 임상경과를 알아보았고, 재발된 환자들의 리바비린(ribavirin)과 인터페론(pegylated Interferon alpha-2a) 치료의 반응 정도를 분석하였다. 대상 및 방법: 1992년 8월부터 2006년 6월까지 서울아산병원에서 C형간염으로 진단받고 생체 부분간이식 수술을 시행받은 39명의 환자들을 대상으로 의무기록을 후향 조사하였으며, 추적기간의 중앙값은 24.9개월이었다. 본원에서는 Protocol 간 조직생검을 시행하지 않기 때문에 이 연구에서는 C형간염의 재발을 간효소 수치의 증가가 있으면서, HCV RNA값이 1.0×107 IU/mL 이상의 증가 소견을 동반한 때로 정의하였다. 결과: 간세포암종 동반 유무에 따른 C형간염 환자의 생체 부분간이식 수술 후 2년 환자 생존율은 간세포암종을 동반한 경우 81.2%, 동반하지 않은 경우 81.3%로 유의한 차이는 없었고, 2년 이식편 생존율은 간세포암종을 동반한 경우 81.2%, 동반하지 않은 경우 68.2%였으나 통계에서 유의성은 없었다. 추적기간 동안 C형간염 재발로 사망한 경우는 없었다. C형간염의 재발은 39명의 환자들 중 26명(66.6%)에서 있었다. 재발은 환자의 86.7%가 이식 후 1년 이내에 있었다. 항바이러스치료는 생체 간이식 수술 시행 이후 C형간염 재발 환자 모두에게 시행하였는데, 리바비린과 인터페론 병합요법으로 치료받은 환자 16명 중 9명에서 추적관찰 기간 동안 HCV RNA가 음전되어 유지되었고, 리바비린 단독으로 치료받은 환자 10명 중에서는 음성으로 전환된 환자가 없었다. 재발에 영향을 주는 인자로는 수혜자의 나이를 제외하고는 통계에서 유의한 인자는 없었다. 결론: 생체 부분간이식 수술 후 C형간염이 재발한 환자들에 대해 리바비린과 인터페론의 병합요법의 적극적인 치료를 시행할 수 있다면 보다 향상된 치료 결과를 기대할 수 있을 것으로 생각한다.
Abstract
Background/Aims: Hepatitis C virus (HCV)-associated cirrhosis is an increasingly frequent indication for liver transplantation (LT). However, HCV recurrence is universal and this immediately occurs following LT, which endangers both the graft and patient survival. We investigated the frequency of posttransplant recurrence of HCV infection and the patient-graft survival, and we analyzed the responses to ribavirin and interferon therapy in the patients with recurrent HCV infection after living donor liver transplantation (LDLT). Methods: We retrospectively reviewed the clinical outcomes of 39 HCV-associated cirrhosis patients who underwent LDLT at Asan Medical Center between August 1992 and June 2006. In this study, the diagnosis of recurrent HCV was made on the basis of increased transaminases and serum HCV RNA levels greater than 10 million IU/mL because protocol liver biopsy was not performed. Results: HCV recurrence was seen in 26 of the 39 LDLT patients (66.7%). 86.7% of recurrence occurred within the first postoperative year. Antiviral treatment was used for all patients with recurrence of HCV. None of the 10 patients receiving ribavirin alone and 9 of 16 patients who received combination therapy with pegylated interferon alpha-2a plus ribavirin became HCV RNA negative and they remained persistently negative during the median follow-up of 24.9 months. Our data indicates that there is no significant factor influencing HCV recurrence except for the recipient’s age. The 2-year patient survival for the HCV patients with HCC and those patients without HCC were 81.2% and 81.3%, respectively (P=0.85) and the 2-year graft survival rates were 81.2% and 68.2%, respectively (P=0.29). No patient died from HCV recurrence during the follow-up period. Conclusions: Combination therapy with ribavirin and interferon appears to improve the outcome of recurrent HCV infected patients after LDLT.
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