Liu Jian, Wu Guo-cong, Zhang Zhong-tao, Wu Ping, Zhang Dong, Sun Ming-chang, Gao Dong-chen, Wang Yu, Jia Ji-dong, Wang Bao-en
Department of General Surgery, Beijing Friendship Hospital, Capital University of Medical Sciences, Beijing 100050, China.
Zhonghua Wai Ke Za Zhi. 2005 Aug 1;43(15):976-9.
To study the efficacy of the protocol of combination of lamivudine with low dosage hepatitis B immuno-globulin (HBIG) to prevent HBV reinfection and of the treatment for HBV reinfection after liver transplantation.
From December 2000 to May 2003, 11 patients (follow-up is more than 1 year) had been transplanted due to HBV related end-stage liver disease or hepatocellular carcinoma. All patients received the protocol of combination of lamivudine with low dosage HBIG to prevent HBV reinfection after liver transplantation. Lamivudine was administered for more than 2 weeks. Preoperatively patients with HBV-DNA(-) and HBeAg(-) accepted HBIG 2000 IU intramuscular injection. Patients with HBV-DNA(+) or HBeAg(+) before operation accepted HBIG 4000 IU intramuscular injection, and patients with both HBV-DNA(+) and HBeAg(+) before operation accepted HBIG 6000 IU intramuscular injection. All patients took long-term lamivudine postoperatively. They accepted HBIG 800 IU/d for 1 week after transplantation. Two weeks after operation, dosage of HBIG was adjusted so that the titer of HBsAb was higher than 500 IU/L, but lower than 1000 IU/L, and this treatment lasted for 6 months. 6 months after operation, dosage of HBIG was adjusted so that tite of HBsAb higher than 300 IU/L but lower than 500 IU/L, and this treatment lasted for 6 months. One year after operation, dosage of HBIG was adjusted so that tite of HBsAb was higher than 100 IU/L but lower than 300 IU/L, and this treatment lasted for a long time. Examinations of liver function, HBV-DNA and hepatitis B were regularly taken. To observe the early turning to be negative rate, the later HBV reinfection rate, and the efficacy of the treatment for HBV reinfection.
HBsAg, HBeAg and HBV-DNA in all patients turned to be negative in 1-4 days after operation. All patients responded to HBIG, and level of titer of HBsAb was elevated gradually. All patients was alive during the observation time. The regular examination of HBsAb showed that of HBsAb was in line with our expectation. Hepatitis B recurrence occurred in 1 patient 25 months after transplantation. Through using adefovir and adding the dosage of HBIG, the hepatitis B is in control.
The protocol of combination of lamivudine with low dosage HBIG proved to be highly effective and safe in preventing the recurrence of HBV after liver transplantation. It also reduced the cost obviously.
研究拉米夫定联合小剂量乙肝免疫球蛋白（HBIG）预防肝移植术后乙肝病毒（HBV）再感染及治疗HBV再感染的疗效。
2000年12月至2003年5月，11例因HBV相关终末期肝病或肝细胞癌接受肝移植的患者（随访时间超过1年）。所有患者均采用拉米夫定联合小剂量HBIG预防肝移植术后HBV再感染。拉米夫定服用超过2周。术前HBV-DNA（-）和HBeAg（-）的患者接受2000IU HBIG肌肉注射。术前HBV-DNA（+）或HBeAg（+）的患者接受4000IU HBIG肌肉注射，术前HBV-DNA（+）且HBeAg（+）的患者接受6000IU HBIG肌肉注射。所有患者术后长期服用拉米夫定。移植后1周内接受800IU/d HBIG。术后2周，调整HBIG剂量，使乙肝表面抗体（HBsAb）滴度高于500IU/L但低于1000IU/L，该治疗持续6个月。术后6个月，调整HBIG剂量，使HBsAb滴度高于300IU/L但低于500IU/L，该治疗持续6个月。术后1年，调整HBIG剂量，使HBsAb滴度高于100IU/L但低于300IU/L，并长期维持该治疗。定期进行肝功能、HBV-DNA及乙肝相关检查。观察早期转阴率、后期HBV再感染率及HBV再感染的治疗效果。
所有患者术后1-4天内HBsAg、HBeAg及HBV-DNA均转阴。所有患者对HBIG反应良好，HBsAb滴度逐渐升高。观察期间所有患者均存活。HBsAb定期检查结果符合预期。1例患者移植后25个月发生乙肝复发。通过使用阿德福韦并增加HBIG剂量，乙肝得到控制。
拉米夫定联合小剂量HBIG方案在预防肝移植术后HBV复发方面证明是高效且安全的。同时也显著降低了费用。
