Shitrit Ariella Bar-Gil, Kramer Mordechai R, Bakal Ilana, Morali Gilles, Ben Ari Ziv, Shitrit David
Gastroenterological Department, Shaare Zedek Medical Center, Jerusalem, Israel.
Ann Thorac Surg. 2006 May;81(5):1851-2. doi: 10.1016/j.athoracsur.2005.12.026.
Several reports have shown the efficacy of prophylactic lamivudine treatment for hepatitis B virus (HBV) infection in liver and renal transplantations. No data are available, however, after lung transplantation. We report our experience with prophylactic lamivudine treatment in lung transplant recipients with HBV infection or when the donor was HBc antibody positive.
All our 120 lung transplant recipients and their donors were routinely screened for HBV markers. All recipients who tested positive for hepatitis B surface antigen and negative for HBV-DNA, or had organs from donors who tested positive for hepatitis B core antibody, were treated prophylactically with lamivudine for 12 months after lung transplantation. Patients whose liver functions became abnormal during follow-up were tested for HBV serology and HBV-DNA.
Eleven of 120 lung transplant recipients (9.2%) were treated with prophylaxis lamivudine. Four recipients were hepatitis B surface antigen positive, and 7 recipients received organs from donors positive for HBc antibodies. Median follow-up after treatment was 24 months. All patients had normal alanine transaminase and undetectable levels of HBV-DNA before treatment. No side effects of lamivudine therapy were reported by any of the patients. Reactivation with alanine transaminase elevation and high HBV-DNA levels occurred in 2 patients. Both of them were recipients positive for hepatitis B surface antigen. In the first patient, lamivudine-resistant strain was detected and adefovir dipivoxil was started. In the other, reactivation developed 2 months after the end of lamivudine treatment. Lamivudine treatment was resumed, with rapid normalization of the HBV-DNA.
Use of lamivudine is considered safe for suppressing HBV infection after lung transplantation.
多项报告显示，预防性使用拉米夫定治疗可有效预防肝移植和肾移植中的乙型肝炎病毒（HBV）感染。然而，肺移植后尚无相关数据。我们报告了对感染HBV或供体乙肝核心抗体阳性的肺移植受者进行预防性拉米夫定治疗的经验。
对我们所有的120例肺移植受者及其供体进行了HBV标志物的常规筛查。所有乙肝表面抗原检测呈阳性且HBV-DNA检测呈阴性的受者，或接受了乙肝核心抗体检测呈阳性供体器官的受者，在肺移植后均接受了12个月的拉米夫定预防性治疗。对随访期间肝功能异常的患者进行了HBV血清学和HBV-DNA检测。
120例肺移植受者中有11例（9.2%）接受了拉米夫定预防性治疗。4例受者乙肝表面抗原呈阳性，7例受者接受了乙肝核心抗体呈阳性供体的器官。治疗后的中位随访时间为24个月。所有患者治疗前丙氨酸转氨酶均正常，HBV-DNA检测不到。所有患者均未报告拉米夫定治疗的副作用。2例患者出现丙氨酸转氨酶升高和高HBV-DNA水平的再激活。他们均为乙肝表面抗原呈阳性的受者。在第一例患者中，检测到拉米夫定耐药株，并开始使用阿德福韦酯。在另一例患者中，拉米夫定治疗结束2个月后出现再激活。重新开始拉米夫定治疗后，HBV-DNA迅速恢复正常。
拉米夫定用于抑制肺移植后HBV感染被认为是安全的。
