ГЕПАТИТ Е: НОВАЯ ПРОБЛЕМА ТРАНСПЛАНТОЛОГИИ?

Hepatitis E is enterically transmitted infection and is the cause of outbreaks and sporadic cases. Disease was originally registered only in the developing subtropical and tropical countries and has been connected with I or II genotypes of hepatitis E virus (HEV). Later sporadic hepatitis E has been registered in a number of the deve- loped countries of Western Europe, North America, South East Asia and Ocenia. These cases have been caused, as a rule, by III or IV genotypes of HEV. Until recently it was considered, that the disease is usually self-limited except pregnant women in which HEV infection is more severe, often leading to fulminant liver failure and death in a significant proportion of patients. The current review represents the analysis of publications of the last years reflecting the facts that HEV infection may develop in immunosuppressed patients, in particular in liver transplant recipients, who may then serve as long-term carriers of the virus with progression to cirrhosis. The information on the first attempts of antiviral therapy in these patients is presented. Гепатит Е относится к группе энтеральных гепатитов и может иметь характер как эпидемической, так и спорадической инфекции. Заболевание первоначально регистрировалось только в развивающихся суб- тропических и тропических странах и было связано с заражением I или II генотипами вируса. Позже спо- радический гепатит Е был зарегистрирован в ряде развитых стран Западной Европы, Северной Америки, Юго-Восточной Азии и Океании. Эти случаи были обусловлены инфицированием, как правило, III или IV генотипами вируса гепатита Е (HEV). До недавнего времени считалось, что течение болезни имеет об- ратимый характер и обычно завершается выздоровлением за исключением случаев заражения женщин на поздних сроках беременности, у которых была описана возможность развития фульминантного гепатита. Настоящий обзор посвящен анализу публикаций последних лет, отражающих течение HEV-инфекции у больных с иммунодефицитом, в частности у реципиентов трансплантатов солидных органов, для кото- рых совсем недавно была показана возможность хронизации болезни и трансформации ее в цирроз пече- ни. Представлена информация о первых попытках противовирусной терапии у этих больных.

HEPATITIS E: А NEW PROBLEM IN TRANSPANTOLOGY?

Hepatitis E is enterically transmitted infection and is the cause of outbreaks and sporadic cases. Disease was originally registered only in the developing subtropical and tropical countries and has been connected with I or II genotypes of hepatitis E virus (HEV). Later sporadic hepatitis E has been registered in a number of the deve- loped countries of Western Europe, North America, South East Asia and Ocenia. These cases have been caused, as a rule, by III or IV genotypes of HEV. Until recently it was considered, that the disease is usually self-limited except pregnant women in which HEV infection is more severe, often leading to fulminant liver failure and death in a significant proportion of patients. The current review represents the analysis of publications of the last years reflecting the facts that HEV infection may develop in immunosuppressed patients, in particular in liver transplant recipients, who may then serve as long-term carriers of the virus with progression to cirrhosis. The information on the first attempts of antiviral therapy in these patients is presented

The modern options of chronic hepatitis C antiviral therapy with daclatasvir: results of named patient program

Introduction. The options of antiviral therapy (AVT) in the stages of severe liver fibrosis and cirrhosis (LC) as well as in the patients with comorbidities for the long time were limited to the standard therapy by pegilated interferon (peg-IFN) in combination to ribavirin (RBV). Before official registration of interferon-free treatment modes in 2015 experience of the application was limited to clinical trials or treatment within early approach programs. Aim of investigation. To analyze the efficacy of PTV for chronic hepatitis C within the named patient program of expanded access to daclatasvir. Material and methods. Approval of Ministry of Healthcare of the Russian Federation to import of drugs was received for the treatment of 101 HCV-infected patients with compensated LC, who, been untreated had an urgent need for effective therapy, with estimated life expectancy less than 12 months, in 12 centers of the Russian Federation. The patients with 1b HCV genotype received treatment by combination of daclatasvir and asunaprevir 100 mg, patients with 2 and 3 HCV genotypes, and those with 1b HCV genotype after the liver transplantation received daclatasvir to sofosbuvir combination. Results. Sustained virologic response for 24 wks (SVR24) in early approach program was 89% (83 of 93) of patients with severe liver disease who urgently needed effective treatment with estimated life expectancy of less than 12 months if been untreated. In group of the patients receiving treatment mode of daclatasvir + asunaprevir the frequency of SVR24 achievement was 90%. Of 93 patients who underwent complete treatment course no severe adverse effects were registered. During treatment infrequent nonspecific adverse events, such as a headache and fatigue were observed. No significant elevation of alanine transaminase and aspartate aminotransferase activity, or bilirubin level were detected. Conclusions. Daclatasvir combination to asunaprevir or sofosbuvir demonstrated high efficacy, including that at treatment of patients with poor prognostic signs

Management of Chronic Hepatitis B in Special Populations: Immunosuppressed Patients and Chronic Kidney Disease

Hepatitis B virus (HBV) infection remains an important cause of liver disease in the population with chronic kidney disease, including patients on long-term dialysis and renal transplant (RT) recipients. Diminished survival due to hepatitis B has been observed after RT. A thorough evaluation, including liver biopsy as well as assessment of serum markers of HBV replication (ie, hepatitis B e antigen and/or HBV DNA) is required before transplantation. Tolerance to interferon is poor both in dialysis patients and after renal transplant. Oral antiviral therapy now permits safe and potent antiviral treatment of HBV-related liver disease in chronic kidney disease patients with prevention of progressive liver disease. Preliminary evidence shows an improved survival of HBsAg positive renal allograft recipients on antiviral therapy. However, numerous issues concerning the treatment of hepatitis B in the population with chronic kidney disease remain unclear and further clinical trials are needed

Hepatic disorders in chronic kidney disease

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are the most common and serious causes of liver damage in patients with chronic kidney disease (CKD). The natural histories of HBV and HCV infections in patients with CKD are not fully understood; however, recent evidence has emphasized the adverse effect of HBV and/or HCV infection on survival in this population. Chronic liver disease is the fourth most important cause of death after renal transplantation. The negative effect of HCV infection on survival among renal transplant recipients has been linked to liver dysfunction and extrahepatic complications, such as chronic glomerulonephritis, post-transplantation diabetes mellitus, chronic allograft nephropathy, and sepsis. The transmission of HCV by solid organ transplantation has been unequivocally demonstrated. Renal transplant recipients who receive kidneys from HCV-positive donors are at increased risk of death. Although several studies have shown that in patients with HCV infection and chronic renal failure renal transplantation is associated with better survival than is dialysis, recent clinical guidelines recommend that kidneys from HCV-infected donors should not be used in HCV-seropositive recipients without detectable HCV viremia. Monotherapy with conventional interferon has been suggested to be a useful treatment for hepatitis C infection in patients on dialysis. Although no evidence suggests that patients with CKD are more prone to suffer from hepatic toxic effects than individuals with normal kidney function, patients with CKD usually receive multiple medications; and drug interactions may, therefore, have a role in the pathogenesis of drug-induced liver disease in this population