Prevention of hepatitis B recurrence after living donor liver transplantation: Primary high-dose hepatitis B immunoglobulin monotherapy and rescue antiviral therapy
Prevention of hepatitis B recurrence after living donor liver transplantation: Primary high-dose hepatitis B immunoglobulin monotherapy and rescue antiviral therapy
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DOI：
10.1002/lt.21440
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发表时间：
2008-06-01
影响因子：
4.6
通讯作者：
Lim, Young-Suk
中科院分区：
文献类型：
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作者：
Hwang, Shin;Lee, Sung-Gyu;Lim, Young-Suk
对感染乙肝病毒的患者进行肝移植后，预防乙肝病毒的复发是至关重要的。我们评估了1997年2月至2004年12月间接受活体供肝移植(LDLT)的639名乙肝病毒感染的成人患者的初次大剂量乙肝免疫球蛋白(HBIG)单一疗法和抢救性抗病毒疗法的疗效。总的5年生存率为80.7%，肝细胞癌复发是晚期死亡的最常见原因。392例(61.3%)患者在移植前观察到了乙肝病毒复制。10,000-IU HBIG维持乙肝表面抗原-GT；500IU/L抗体的间隔时间为30天占11.4%，40~50天占72.1%，60天占16.5%。在最后一次随访时，3.9%的无乙肝复发患者接受了联合治疗。总体1年、3年、5年和10年的乙肝病毒复发率分别为1.4%、5.5%、7.3%和8.5%。肝移植术后平均25.7+/-16.4个月出现乙肝复发。在乙肝复发后，9例患者中有5例在阿德福韦治疗前死于快速进行性肝功能衰竭，29例患者中只有1例在阿德福韦治疗后死亡。需要频繁地输注HBIG(
The prevention of hepatitis B virus (HBV) recurrence is essential after liver transplantation in patients infected with HBV. We evaluated the efficacy of primary high-dose hepatitis B immunoglobulin (HBIG) monotherapy and rescue antiviral therapy in 639 HBV-infected adult patients who underwent living donor liver transplantation (LDLT) between February 1997 and December 2004. The overall 5-year survival rate was 80.7%, and recurrence of hepatocellular carcinoma was the most common cause of late mortality. Pretransplant HBV replication was observed in 392 (61.3%) patients. The interval of 10,000-IU HBIG administration to maintain antibody to hepatitis B surface antigen > 500 IU/L was 30 days in 11.4% patients, 40 to 50 days in 72.1%, and 60 days in 16.5%. At the last follow-up, 3.9% of the patients without HBV recurrence were receiving combination therapy. Overall 1-year, 3-year, 5-year, and 10-year HBV recurrence rates were 1.4%, 5.5%, 7.3%, and 8.5%, respectively. HBV recurrence occurred after a mean of 25.7 +/- 16.4 months after LDLT. After HBV recurrence, 5 of 9 patients died from rapidly progressive liver failure before treatment with adefovir, and only 1 of 29 patients died after treatment with adefovir. Need for frequent HBIG infusions (