肝がんの移植とアフェレシス : C型肝炎症例におけるDFPPを用いた術後抗ウイルス療法(<特集>がん疾患とアフェレシス)

概要

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Recurrence of hepatitis C is a lingering problem in liver transplantation (LTx) for hepatitis C-associated hepatocellular carcinoma. Since a double filtration plasmapheresis (DFPP) theoretically removes hepatitis C virus (HCV), we applied this modality as a prophylactic treatment to 6 recipients with a high-titer of HCV (>1,000KIU/mL). DFPP was commenced on 26.5 days after LTx on average, and consecutively performed for 5 days followed by long-term interferon and ribavirin (IFN-Rib) therapy. DFPP remarkably reduced HCV-RNA levels and seemed to enhance the response to subsequent IFN-Rib therapy. Although a sustained viral response was achieved in one case, the long-term effect was not confirmed in the others due to low tolerability to DFPP and/or IFN-Rib. As a treatment for recurrence, DFPP exhibited a dramatic effect especially in a patient developing fibrosing cholestatic hepatitis, which is caused by high replication of HCV virus and characterized by rapid evolution to hepatic failure. From our data, DFPP exhibited a short-term effect in reducing HCV viremia; however, larger cohorts are necessary to draw firm conclusions for its long-term effects.
2009-05-31