Introduction: Liver disease caused by hepatitis C virus is the leading cause of liver
transplantation in the United States and Europe. Unfortunately, recurrence of hepatitis C virus
is universal, causing major impact in these patients. Treatment of hepatitis C virus in the posttransplant
is a challenge due to poor tolerance and low success rate. Objective: To evaluate
the response to hepatitisC virustreatment in patients undergoing liver transplantation at the
HUWC / UFC. Methods:From May 18th 2002 to December 18th 2011, 601 patients
underwent liver transplantation at the HUWC / UFC from which 176 (29,2%) with hepatitis C
virus. Forty patients underwent therapy for hepatitis C after liver transplantation and included
in the current study. The sustained virologic response (SVR) was determined, as well as
factors associated with SVR and patient survival. Results:The mean age of patients was 53,33
years and 32 (80%) were male. The mean donor age was 42,88 years. Twenty-six patients
(65%) were infected with genotype 1. Eight patients (20%) were exposed to hepatitis C virus
treatment in the pre-transplant period. Twenty-eight (70%)patients completed the treatment
protocol, composed of PEG-INF and RBV for 48 weeks. Only 1patient developed cellular
rejection during treatment. The SVR rate was 55%, by intention to treat analysis. The
recipient age and the exposure to antiviral treatment in the pre-transplant period were
associated with SVR factors in multivariate analysis. Patients were followed up for 57 months
on average. Eleven patients died during the study. Survival of patients who achieved RVS at
1, 3 and 5 years was 100%, while in those who did not achieved SVR was 100%, 90% and
78% respectively. Conclusion: The SVR rate was 55%.The SVR rate decreased with
increasing age of the receptor. Exposure to antiviral treatment in the pre-transplant period had
a negative impact on SVR rate. The overall survival of patients who achieved an SVR was
similar to patients who have not achieved an SVR. / IntroduÃÃo: A doenÃa hepÃtica causada pelo vÃrus da hepatite C (VHC) Ã a principal causa de
transplante hepÃtico nos Estados Unidos e na Europa. Infelizmente, a recidiva do VHC Ã
universal e tem importante impacto na evoluÃÃo desses pacientes. O tratamento da hepatite C
no perÃodo pÃs-trasnplante à um desafio, tendo em vista a pouca tolerÃncia e as baixas taxas
de sucesso. Objetivos: Avaliar a resposta ao tratamento da hepatite C em pacientes
submetidos a transplante hepÃtico no HUWC/UFC. MÃtodos: Durante o perÃodo de 18 de
maio de 2002 a 18 de dezembro de 2011, 601 pacientes foram submetidos a transplante
hepÃtico no Hospital UniversitÃrio Walter CantÃdio/Universidade Federal de CearÃ
(HUWC/UFC), sendo 176(29,2%) portadores de hepatite C. Destes, quarenta pacientes
realizaram tratamento contra o VHC apÃs o transplante e foram incluÃdos no presente estudo.
Foram determinadas a RVS, assim como fatores associados com a RVS e a sobrevida dos
pacientes. Resultados: A mÃdia de idade dos pacientes foi de 53,33 anos, sendo 32 (80%) do
gÃnero masculino. A mÃdia de idade dos doadores foi de 42,88 anos. Vinte e seis pacientes
(65%) eram infectados pelo genÃtipo 1. Oito pacientes (20%) haviam sido expostos, no
perÃodo prÃ-transplante, a tratamento antiviral para o VHC. Vinte e oito (70%) pacientes
concluÃram o protocolo de tratamento proposto, composto de interferon-peguilado e ribavirina
por 48 semanas. Apenas 1 paciente desenvolveu rejeiÃÃo celular durante o tratamento. A taxa
de RVS foi de 55%, por intenÃÃo de tratar. A idade do receptor e a exposiÃÃo a tratamento
antiviral no perÃodo prÃ-transplante foram fatores associados com a RVS na anÃlise
multivariada. Os pacientes foram acompanhados por 57 meses em mÃdia. Onze pacientes
foram a Ãbito durante o estudo. A sobrevida em 1, 3 e 5 anos dos pacientes que obtiveram
RVS foi de 100%, enquanto que nos que nÃo obtiveram RVS foi de 100%, 90% e 78%
respectivamente. ConclusÃes: A taxa de RVS foide 55%. A taxa de RVS decresceu com o
aumento da idade do receptor. A exposiÃÃo a tratamento antiviral no perÃodo prÃ-transplante
teve impacto negativo na taxa de RVS. A sobrevida global dos pacientes com e sem RVS foi
semelhante.
| Identifer | oai:union.ndltd.org:IBICT/oai:www.teses.ufc.br:8526 |
| Date | 29 April 2014 |
| Creators | Antonio Haroldo de Araujo Filho |
| Contributors | Josà Huygens Parente Garcia, Josà Milton de Castro Lima, Alberto Queiroz Farias |
| Publisher | Universidade Federal do CearÃ, Programa de PÃs-GraduaÃÃo em Cirurgia, UFC, BR |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da UFC, instname:Universidade Federal do Ceará, instacron:UFC |
| Rights | info:eu-repo/semantics/openAccess |
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