Hepatitis B immunoglobulin discontinuation followed by hepatitis B virus vaccination: A new strategy in the prophylaxis of hepatitis B virus recurrence after liver transplantation
Hepatitis B immunoglobulin discontinuation followed by hepatitis B virus vaccination: A new strategy in the prophylaxis of hepatitis B virus recurrence after liver transplantation
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DOI：
10.1002/hep.510310233
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发表时间：
2000-02-01
期刊：
影响因子：
13.5
通讯作者：
Rodes, J
中科院分区：
文献类型：
--
作者：
Sanchez-Fueyo, A;Rimola, A;Rodes, J
人们普遍认为，对于因B型肝炎病毒（HBV）相关疾病而接受移植的患者，应给予B型肝炎病毒免疫球蛋白（HBIG）至少12个月，以预防HBV复发。然而，没有数据可以说明这种治疗应该使用多长时间，大多数中心目前都在终身基础上管理HBIG。在此，我们报告了一种新的预防策略的结果，该策略旨在停止HBIG治疗，并包括给予双倍剂量重组HBV疫苗（0、1和6个月时间表）向符合以下标准的肝移植受者提供：（1）非复制型HBV感染相关疾病的肝移植（B型肝炎表面抗原[HBsAg]阳性，B型肝炎e抗原[HBeAg]阴性，HBV DNA阴性）;（2）至少18个月的HBIG给药;（3）接种时无HBV感染复发，移植肝功能正常或轻度改变，免疫抑制程度低。17例患者接受了HBV疫苗接种，其中14例（82%）产生了保护性血清抗-HBs滴度（>10 IU/L）。6名患者在第一个疗程疫苗接种后发生血清转化，而8名患者需要第二个疗程（额外接种3剂疫苗）。应答患者在血清转换后中位随访14个月（范围，3-50）。在此期间，没有发生HBV复发，只有2例患者的抗-HBs滴度下降低于10 UI/L。我们的数据表明，在选定的肝移植受者，移植后乙肝疫苗接种可能是一个有用的和成本效益的策略，在预防乙肝复发，允许终身HBIG治疗的中断。
It is widely agreed that hepatitis B virus immunoglobulin (HBIG) should be administered for at least 12 months to patients transplanted for hepatitis B virus (HBV)-related diseases to prevent HBV recurrence. No data are available, however, on how long this treatment should be used, and most centers currently administer HBIG on a life-long basis. Herein, we report the results of a new prophylactic strategy aiming at the discontinuation of HBIG treatment and consisting of the administration of double dose recombinant HBV vaccine (0, 1-, and 6-month schedule) to liver transplant recipients fulfilling the following criteria: (1) liver transplantation for conditions related to nonreplicative HBV infection (hepatitis B surface antigen [HBsAg] positive, hepatitis B e antigen [HBeAg] negative, and HBV DNA negative); (2) at least 18 months of HBIG administration; and (3) no HBV infection recurrence, normal or slightly altered liver graft function, and low-grade immunosuppression at the time of vaccination. Seventeen patients received HBV vaccination and 14 of them (82%) developed protective serum titers of anti-HBs (>10 IU/L). Six patients seroconverted after a first course of vaccination, whereas 8 patients required a second course (3 additional doses of vaccine). Responding patients were followed for a median of 14 months (range, 3-50) after seroconversion. During this period no HBV recurrence occurred and in only 2 patients a decrease of anti-HBs titers below 10 UI/L was observed. Our data suggest that in selected liver transplant recipients, posttransplantation HBV vaccination may be a useful and cost-effective strategy in the prophylaxis of HBV recurrence, allowing the discontinuation of life-long HBIG treatment.