Terrault Norah A, Carter Jonathan T, Carlson Laurie, Roland Michelle E, Stock Peter G
Department of Medicine, University of California at San Francisco, San Francisco, CA 64143-0538, USA.
Liver Transpl. 2006 May;12(5):801-7. doi: 10.1002/lt.20776.
The outcome of patients with hepatitis B virus (HBV) and human immunodeficiency virus (HIV) referred for liver transplantation (LT) is unknown. A high frequency of lamivudine-resistant (LAM-R) HBV infection may increase the risk of liver-related death pre-transplantation and prophylaxis failure post-transplantation. We evaluated the association of LAM-R HBV on pre-transplant survival and post-transplant outcomes in 35 consecutive HIV-HBV coinfected patients referred for LT between July 2000 and September 2002. At the time of referral, the median CD4 count was 273/mm, MELD was 14, and LAM-R HBV infection was present in 67%. Among these referred patients, 26% were listed, 29% not listed due to relative/absolute contraindications; 26% not listed as too early for LT; 9% not listed as too sick for LT; and 11% died during transplant evaluation. Of the 9 listed patients, 4 remained listed, 1 died 18 months post-referral, and 4 were transplanted (11% of total) 3 to 40 months after listing. Of 17 evaluated but not listed patients, 5 died (p=0.38 compared to listed group) and all deaths were liver-related. All the HBV-HIV coinfected patients, who were transplanted, are HBsAg negative and have undetectable HBV DNA levels on prophylactic therapy using hepatitis B immune globulin (HBIG) plus lamivudine, with and without tenofovir or adefovir, with median 33.1 months follow-up. Late referral and the presence of LAM-R HBV pre-transplantation are common in referred HIV-HBV patients. In HIV-HBV coinfected patients undergoing LT, HBV recurrence is successfully prevented with combination prophylaxis using HBIG and antivirals.
接受肝移植（LT）的乙型肝炎病毒（HBV）和人类免疫缺陷病毒（HIV）合并感染患者的预后尚不清楚。拉米夫定耐药（LAM-R）HBV感染的高频率可能会增加移植前肝脏相关死亡风险以及移植后预防失败的风险。我们评估了2000年7月至2002年9月期间连续35例因LT转诊的HIV-HBV合并感染患者中LAM-R HBV与移植前生存及移植后结局的相关性。转诊时，CD4细胞计数中位数为273/mm，终末期肝病模型（MELD）评分为14，67%的患者存在LAM-R HBV感染。在这些转诊患者中，26%被列入等待名单，29%因相对/绝对禁忌证未被列入；26%因LT时机过早未被列入；9%因病情过重不适宜LT未被列入；11%在移植评估期间死亡。在9例被列入等待名单的患者中，4例仍在等待名单上，1例在转诊后18个月死亡，4例（占总数的11%）在列入名单后3至40个月接受了移植。在17例接受评估但未被列入等待名单的患者中，5例死亡（与列入等待名单组相比，p = 0.38），所有死亡均与肝脏相关。所有接受移植的HBV-HIV合并感染患者，在使用乙肝免疫球蛋白（HBIG）加拉米夫定进行预防性治疗时，无论是否联合替诺福韦或阿德福韦，HBsAg均为阴性且HBV DNA水平检测不到，中位随访时间为33.1个月。晚期转诊以及移植前存在LAM-R HBV在转诊的HIV-HBV患者中很常见。在接受LT的HIV-HBV合并感染患者中，使用HBIG和抗病毒药物联合预防可成功预防HBV复发。
