Chen Yaw-Sen, Wang Chih-Chi, de Villa Vanessa H, Wang Shih-Hor, Cheng Yu-Fan, Huang Tung-Liang, Jawan Bruno, Chiu King-Wah, Chen Chao-Long
Department of Surgery, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan.
Clin Transplant. 2002 Dec;16(6):405-9. doi: 10.1034/j.1399-0012.2002.01133.x.
Exclusion of liver grafts from hepatitis B core antibody (anti-HBc) positive donors to prevent de novo hepatitis B virus (HBV) infection after liver transplantation is not feasible in areas highly endemic for HBV virus like Taiwan, where approximately 80% of adults are anti-HBc(+). The efficacy of lamivudine monotherapy to prevent de novo HBV infection after living donor liver transplantation (LDLT) using grafts from anti-HBc(+) donors remains to be elucidated. From June 1994 to August 2000, LDLT was performed in 42 recipients. Twenty-four of the 42 donors were anti-HBc(+) (57%). Pre-transplant HBV vaccination was given to all recipients irrespective of anti-HBc status at monthly intervals for 3 months. Until December 1997, eight recipients received liver grafts from anti-HBc(+) donors without prophylaxis. Since January 1998, prophylaxis with lamivudine monotherapy was given to 16 recipients receiving liver grafts from anti-HBc(+) donors. De novo HBV infection occurred in three of the eight recipients (37.5%) who did not receive prophylaxis, while none of the 16 recipients given lamivudine developed de novo HBV infection after a mean follow-up of 25 months. Two of the three recipients with de novo HBV infection were anti-HBs(-) and one recipient was anti-HBs(+). Lamivudine was well tolerated, and no side effects were noted. These results suggest that lamivudine monotherapy for recipients receiving anti-HBc(+) liver grafts is a simple, relatively inexpensive and effective prophylactic regimen for prevention of de novo HBV infection. The additive protection provided by vaccine-induced or natural immunity is uncertain.
在台湾等乙肝病毒（HBV）高度流行的地区，排除乙肝核心抗体（抗-HBc）阳性供体的肝脏移植以预防肝移植后新发HBV感染是不可行的，因为在台湾约80%的成年人抗-HBc呈阳性。拉米夫定单药疗法预防使用抗-HBc阳性供体肝脏进行活体肝移植（LDLT）后新发HBV感染的疗效仍有待阐明。1994年6月至2000年8月，对42例受者进行了LDLT。42例供体中有24例抗-HBc阳性（57%）。所有受者无论抗-HBc状态如何，均在术前每月接种一次HBV疫苗，共接种3个月。直到1997年12月，8例受者接受了来自抗-HBc阳性供体的肝脏移植且未进行预防。自1998年1月起，16例接受来自抗-HBc阳性供体肝脏移植的受者接受了拉米夫定单药预防治疗。未接受预防治疗的8例受者中有3例（37.5%）发生了新发HBV感染，而接受拉米夫定治疗的16例受者在平均随访25个月后均未发生新发HBV感染。3例新发HBV感染的受者中有2例抗-HBs阴性，1例抗-HBs阳性。拉米夫定耐受性良好，未观察到副作用。这些结果表明，拉米夫定单药疗法对接受抗-HBc阳性肝脏移植的受者来说是一种简单、相对便宜且有效的预防新发HBV感染的方案。疫苗诱导的或自然免疫提供的额外保护尚不确定。
