Loomba Rohit, Rowley Ayana K, Wesley Robert, Smith Karen G, Liang T Jake, Pucino Frank, Csako Gyorgy
Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland 20892, USA.
Clin Gastroenterol Hepatol. 2008 Jun;6(6):696-700. doi: 10.1016/j.cgh.2008.02.055. Epub 2008 May 5.
BACKGROUND & AIMS: HBV recurrence increases morbidity and mortality in HBsAg+ patients undergoing liver transplantation. We aimed to estimate the relative efficacy of combined therapy with hepatitis B immunoglobulin (HBIG) and lamivudine (LAM) versus HBIG monotherapy for preventing HBV-related morbidity and mortality in this setting.
We performed a meta-analysis of clinical trials that met the prespecified criteria and provided data for risk estimation of HBV recurrence in HBsAg+ liver transplant patients receiving HBIG and LAM versus HBIG alone. Databases searched until May 2007 included MEDLINE (Ovid), PubMed, Embase, Toxnet, Scopus, and Web of Science. Literature search and data extraction were conducted independently by 2 study investigators; then 2 other investigators reviewed and screened eligible studies. Odds ratios (ORs) for the risk reduction with HBIG and LAM versus HBIG alone were calculated by using a random-effects model.
Two prospective and 4 retrospective studies were included in the meta-analysis. The OR showing risk reduction in HBV recurrence with HBIG and LAM (n = 193) versus HBIG alone (n = 124) was 0.08 (95% confidence interval [CI], 0.03-0.21). HBV-related death and all-cause mortality could only be assessed in 3 studies each. The ORs showing HBV-related death and all-cause mortality reduction with HBIG and LAM versus HBIG alone were 0.08 (95% CI, 0.02-0.33) and 0.02 (95% CI, 0.06-0.82), respectively.
Although this meta-analysis was limited by small studies and varying levels of immunosuppression, it is apparent that adding LAM to HBIG improved HBV-related morbidity and mortality in HBsAg+ recipients of liver transplants.
乙肝复发会增加接受肝移植的HBsAg阳性患者的发病率和死亡率。我们旨在评估联合使用乙肝免疫球蛋白（HBIG）和拉米夫定（LAM）与单独使用HBIG预防此类情况下乙肝相关发病率和死亡率的相对疗效。
我们对符合预定标准的临床试验进行了荟萃分析，这些试验提供了接受HBIG和LAM与仅接受HBIG的HBsAg阳性肝移植患者乙肝复发风险估计的数据。截至2007年5月搜索的数据库包括MEDLINE（Ovid）、PubMed、Embase、Toxnet、Scopus和Web of Science。文献检索和数据提取由2名研究调查员独立进行；然后由另外2名调查员对符合条件的研究进行审查和筛选。使用随机效应模型计算HBIG和LAM与单独使用HBIG相比降低风险的比值比（OR）。
荟萃分析纳入了2项前瞻性研究和4项回顾性研究。显示HBIG和LAM（n = 193）与单独使用HBIG（n = 124）相比乙肝复发风险降低的OR为0.08（95%置信区间[CI]，0.03 - 0.21）。乙肝相关死亡和全因死亡率仅在3项研究中进行了评估。显示HBIG和LAM与单独使用HBIG相比乙肝相关死亡和全因死亡率降低的OR分别为0.08（95%CI，0.02 - 0.33）和0.02（95%CI，0.06 - 0.82）。
尽管这项荟萃分析受到研究规模小和免疫抑制水平不同的限制，但显然在HBIG中添加LAM可改善HBsAg阳性肝移植受者的乙肝相关发病率和死亡率。
