Is vaccination against hepatitis B infection indicated in patients waiting for or after orthotopic liver transplantation?
Is vaccination against hepatitis B infection indicated in patients waiting for or after orthotopic liver transplantation?
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DOI：
10.1002/lt.500040208
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发表时间：
1998-03-01
期刊：
影响因子：
--
通讯作者：
Boyer, TD
中科院分区：
文献类型：
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作者：
Chalasani, N;Smallwood, G;Boyer, TD
在等待肝移植的患者中，对B型肝炎感染进行免疫接种是一种常见的做法，但这种做法的有效性尚不清楚。这是一项对等待肝移植和肝移植后的患者对20 μ g重组B型肝炎疫苗的抗体应答的回顾性分析。在完成疫苗接种系列后1-3个月测量对疫苗接种的反应。通过回顾171例因非B型肝炎疾病接受肝移植且未接种疫苗的患者的甲型肝炎感染检测结果，确定肝移植后获得B型肝炎病毒的风险。57名等待移植的患者符合研究条件，仅在9名（16%）中观察到疫苗接种反应。胆汁淤积性肝病患者的应答率（6/14; 43%）显著高于非胆汁淤积性肝病患者（3/43; 7%; P = 0.004）。45例肝移植受者在移植后进行了甲型肝炎免疫接种，只有3例（6.7%）产生了抗体应答。在171例未接受免疫接种和移植前无任何B型肝炎感染证据的患者中，移植后B型肝炎感染的频率为4/171（2.3%）。在等待肝移植和移植后的慢性肝病患者中，重组B型肝炎疫苗的免疫应答率很差。鉴于对疫苗接种的不良反应和移植后获得B型肝炎病毒的低风险，中心需要重新考虑在等待肝移植的患者中常规使用B型肝炎病毒疫苗。版权所有（C）1998美国肝病研究协会。
It is a common practice to immunize patients against hepatitis B infection while they are waiting for liver transplantation, but the efficacy of this practice is unclear. This is a retrospective analysis of the antibody response to 20 mu g of a recombinant hepatitis B vaccine in patients waiting for and after liver transplantation. The response to vaccination was measured 1-3 months after completion of the vaccination series. The risk of acquiring hepatitis B virus after liver transplant was determined by reviewing the results of tests for hepatitis a infection in 171 patients who underwent transplantation for non-hepatitis B diseases and who had not been vaccinated. Fifty-seven patients awaiting transplantation were eligible for the study, and a response to vaccination was observed in only 9 (16%). Patients with cholestatic liver disease had a significantly higher response (6 of 14; 43%) compared with noncholestatic liver disease (3 of 43; 7%; P = .004). Forty-five liver transplant recipients were immunized against hepatitis a after transplantation, and only 3 (6.7%) developed an antibody response. The frequency of posttransplant hepatitis B infection in the 171 patients who were not immunized and who lacked any evidence of hepatitis B infection pretransplantation was 4 of 171 (2.3%). The response rate to immunization with a recombinant hepatitis B vaccine in patients with chronic liver disease who are waiting for a liver transplant and after transplantation is poor. Given the poor response to vaccination and the low risk of acquiring hepatitis B virus after transplantation, centers need to reconsider the routine use of the hepatitis B virus vaccine in patients awaiting liver transplantation. Copyright (C) 1998 by the American Association for the Study of Liver Diseases.