Interferon-alpha 2b improves short-term survival in patients transplanted for chronic liver failure caused by hepatitis B.
Interferon-alpha 2b improves short-term survival in patients transplanted for chronic liver failure caused by hepatitis B.
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干扰素-α 2b 可改善因乙型肝炎引起的慢性肝衰竭而接受移植的患者的短期生存率。
DOI：
10.1111/j.1365-2893.1996.tb00107.x
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发表时间：
1996
影响因子：
2.5
通讯作者：
VanThiel,DH
中科院分区：
文献类型：
--
作者：
Hassanein,T;Colantoni,A;DeMaria,N;VanThiel,DH
肝移植治疗B型肝炎病毒（HBV）所致肝硬化预后差。这主要是由于同种异体移植物几乎普遍再感染，随后在接受免疫抑制时加速肝脏疾病，以及长期生存率降低。由于干扰素-α已被证明对HBV具有抗病毒作用，因此1986年启动了一项研究，以评估干扰素-α治疗对HBV阳性受者肝移植过程的影响。28例由HBV引起的失代偿终末期肝病患者在移植前接受500万、250万或125万单位（MU）的人重组干扰素-α2b（r-IFN-α2b）每日治疗至少14天，并在移植后持续42天。在整个治疗和治疗后阶段测量HBV抗原、HBV抗体、HBV DNA和血清转氨酶水平。19例患者中有10例在移植后存活3个月或更长时间，HBV DNA被消除，并且与通过症状和转氨酶水平检测到的肝炎显著发作相关（P < 0.05）。HBV DNA清除者入组时HBV DNA水平低于未清除者（P < 0.05）。虽然10例B e抗原（HBeAg）患者中有4例转化为B e抗体（HBeAg Ab），但无存活患者长期清除了B表面抗原（HBsAg）。尽管如此，与历史对照组相比，IFN-α治疗患者的移植后生存率显著更好（P < 0.0001，中位随访42个月），并且与因除HBV癌以外的所有实质性肝病原因而移植的患者相似。因此，肝移植围手术期的IFN-α治疗可提高短期生存率，但不能预防同种异体移植物的HBV感染。
Liver transplantation for cirrhosis caused by hepatitis B virus (HBV) has a poor prognosis. This is primarily a consequence of the near universal reinfection of the allograft, subsequent accelerated hepatic disease while receiving immunosuppression, and a reduced long‐term survival. Because interferon‐α has been shown to have an antiviral effect on HBV, a study was initiated in 1986 to assess the effect of interferon‐α therapy on the course of liver transplantation in HBV‐positive recipients. Twenty‐eight patients with decompensated endstage liver disease caused by HBV were treated with 5, 2.5 or 1.25 million units (MU) of human recombinant interferon‐α2b (r‐IFN‐α2b) daily for a minimum of 14 days prior to transplantation and continuing for 42 days post‐transplantation. HBV antigens, HBV antibodies, HBV DNA and serum transaminase levels were measured throughout the treatment and post‐treatment period. HBV DNA was eliminated in 10 of 19 patients, who survived 3 months or more post‐transplantation, and was associated with a significant flare of hepatitis as detected by symptoms and transaminase levels (P < 0.05). Patients who cleared HBV DNA had lower HBV DNA levels (P < 0.05) at entry compared with those who did not. While four of 10 patients with hepatitis B e antigen (HBeAg) converted to hepatitis B e antibody (HBeAb), no surviving patient cleared hepatitis B surface antigen (HBsAg) on a long‐term basis. Nonetheless, post‐transplant survival was significantly better (P < 0.0001, median follow‐up 42 months) in the IFN‐α treated patients as compared with historical controls, and was similar to that of patients transplanted for all causes of parenchymal liver disease other than HBV cancer. Hence IFN‐α therapy in the perioperative liver transplantation period improves short‐term survival but does not prevent HBV infection of the allograft.