Long-term consequences of stopping HBIG and/or nucleotide analogues in liver transplant recipients administered hepatitis B vaccination to prevent HBV reinfection
Long-term consequences of stopping HBIG and/or nucleotide analogues in liver transplant recipients administered hepatitis B vaccination to prevent HBV reinfection
复制标题
为预防 HBV 再感染而接种乙型肝炎疫苗的肝移植受者停止 HBIG 和/或核苷酸类似物的长期后果
DOI：
10.1111/jvh.13164
复制
发表时间：
2019-07-01
影响因子：
2.5
通讯作者：
Lu，Shi-Chun
中科院分区：
文献类型：
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作者：
Duan，Bin-Wei;Tian，Lan-Tian;Lu，Shi-Chun
背景长期使用核苷酸类似物（NAs）和B型肝炎免疫球蛋白（HBIG）是预防B型肝炎病毒（HBV）相关肝病患者肝移植（LT）后HBV再感染的标准预防措施。然而，延长预防策略涉及安全性问题，例如逃逸突变的发展和/或出现耐药菌株，并且还与高成本相关;方法回顾性分析因HBV相关肝病而对B型肝炎疫苗接种有反应的肝移植受者在停用HBIG和/或NAs后，长期随访后，给予预防HBV再感染。然后对这些应答者评估该策略的安全性和有效性。ResultSeventy-eight应答者入组。所有响应者均停用HBIG，其中36人同时停用HBIG和NA。在随访期间，4名接受者在停用HBIG和NAs后发生了HBV再感染，这与HBV逃逸突变相关。没有死亡或移植物丢失发生在recipients在follow-up period.ConclusionA小心撤出HBIG和/或NAs是可行的和安全的应答者接受移植的HBV相关肝病的B型肝炎疫苗接种。
BackgroundThe long‐term administration of nucleotide analogues (NAs) and hepatitis B immune globulin (HBIG) comprises standard prophylaxis for patients with hepatitis B virus (HBV)‐related liver diseases to prevent HBV reinfection after liver transplantation (LT). However, prolonging the prophylaxis strategy involves safety issues, such as the development of escape mutations and/or emerging resistant strains, and is also associated with high costs; further, it remains unclear how long prophylactic treatment should be continued.MethodLiver transplantation recipients responding to hepatitis B vaccination due to HBV‐related liver diseases were retrospectively analysed after stopping HBIG and/or NAs, administered to prevent HBV reinfection, after long‐term follow‐up. The safety and effectiveness of the strategy were then evaluated for these responders.ResultSeventy‐eight responders were enrolled. All responders discontinued HBIG, among which 36 stopped both HBIG and NAs. During follow‐up, four recipients experienced HBV reinfection, which was associated with HBV escape mutations, after the withdrawal of both HBIG and NAs. No death or graft loss occurred in recipients during the follow‐up period.ConclusionA careful withdrawal of HBIG and/or NAs is feasible and safe for responders to hepatitis B vaccination receiving transplants for HBV‐related liver diseases.