Limquiaco Jenny L, Wong John, Wong Vincent W S, Wong Grace L H, Tse Chi-Hang, Chan Hoi-Yun, Kwan Katherine Y Y, Lai Paul B S, Chan Henry L Y
Department of Medicine and Therapeutics and Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
J Med Virol. 2009 Feb;81(2):224-9. doi: 10.1002/jmv.21369.
In Asia Pacific countries, lamivudine is used frequently as the sole prophylaxis for hepatitis B virus (HBV) recurrence after liver transplantation due to financial consideration. The aim was to evaluate the long-term outcome of lamivudine monoprophylaxis with adefovir salvage for liver transplantation in chronic hepatitis B. Consecutive chronic hepatitis B patients who received liver transplantation from 1999 to 2003 and with at least 12 months follow up were studied. Lamivudine monotherapy was used for antiviral prophylaxis and adefovir was added as salvage treatment for recurrence of HBV. Twenty-four patients were followed up for 272 (76-372) weeks post-liver transplantation. HBV recurrence developed in seven patients with cumulative probabilities of 8%, 13%, 28%, 35%, 35%, and 49% in 1, 2, 3, 4, 5, and 6 years. At the time of recurrence of HBV, the HBV DNA level was 910,244 (363 to 9 x 10(8)) copies/ml. On direct sequencing, four patients had rtM204I mutation and three patients HBV DNA levels were too low for sequencing. Six patients had elevated ALT (two patients had ALT >1,000 IU/L and jaundice) but none had hepatic encephalopathy. After adefovir treatment for 150 (91-193) weeks, six (86%) patients had normal ALT. HBV DNA was undetectable in two (29%) patients, 100-1,000 copies/ml in two (29%) patients and 10,000-100,000 copies/ml in three (43%) patients on last visit. No genotypic resistance to adefovir was detected. Lamivudine followed by adefovir salvage is effective for prophylaxis of recurrence of HBV after liver transplantation up to 7 years.
在亚太国家，出于经济考虑，拉米夫定经常被用作肝移植后预防乙型肝炎病毒（HBV）复发的唯一药物。本研究旨在评估拉米夫定单药预防联合阿德福韦挽救治疗对慢性乙型肝炎肝移植患者的长期疗效。对1999年至2003年间接受肝移植且随访至少12个月的连续性慢性乙型肝炎患者进行了研究。采用拉米夫定单药疗法进行抗病毒预防，当HBV复发时加用阿德福韦进行挽救治疗。24例患者在肝移植后接受了272（76 - 372）周的随访。7例患者出现HBV复发，1、2、3、4、5和6年时的累积复发概率分别为8%、13%、28%、35%、35%和49%。HBV复发时，HBV DNA水平为910,244（363至9×10⁸）拷贝/毫升。直接测序结果显示，4例患者存在rtM204I突变，3例患者的HBV DNA水平过低无法测序。6例患者ALT升高（2例患者ALT>1000 IU/L且出现黄疸），但均未发生肝性脑病。接受阿德福韦治疗150（91 - 193）周后，6例（86%）患者的ALT恢复正常。末次随访时，2例（29%）患者的HBV DNA检测不到，2例（29%）患者的HBV DNA为100 - 1000拷贝/毫升，3例（43%）患者的HBV DNA为10,000 - 100,000拷贝/毫升。未检测到对阿德福韦的基因型耐药。拉米夫定序贯阿德福韦挽救治疗对肝移植后HBV复发的预防有效，最长可达7年。
