Hammond Sarah P, Borchelt Anne Marie, Ukomadu Chinweike, Ho Vincent T, Baden Lindsey R, Marty Francisco M
Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Biol Blood Marrow Transplant. 2009 Sep;15(9):1049-59. doi: 10.1016/j.bbmt.2009.05.001. Epub 2009 Jun 26.
Reactivation of resolved hepatitis B virus (HBV) infection has been reported in allogeneic hematopoetic stem cell transplantation (HSCT) recipients, but its epidemiology is not well characterized. We performed a retrospective assessment of the timing and risk factors of HBV reactivation among patients with resolved HBV infection undergoing allogeneic HSCT between January 2000 and March 2008. HBV reactivation was defined as development of positive hepatitis B surface antigen after transplant. Among the 61 patients with resolved HBV infection before transplant (hepatitis B core antibody-positive, hepatitis B surface antigen-negative), 12 (19.7%) developed HBV reactivation. The cumulative probability of HBV reactivation 1, 2, and 4 years after transplant was 9.0%, 21.7%, and 42.9%, respectively. In a time-dependent Cox model, the adjusted hazard ratio (HR) of HBV reactivation for patients with pretransplant hepatitis B surface antibody levels <10 milli-international units per milliliter (mIU/mL) was 4.56 (95% confidence interval [CI] 1.23-16.9) compared to those with levels > or =10 mIU/mL; the adjusted HR among patients who developed extensive chronic graft-versus-host disease (cGVHD) was 7.21 (95% CI 1.25-41.5) compared to those who did not. HBV reactivation is a common late complication among allogeneic HSCT recipients with pretransplant resolved infection. Screening for HBV reactivation should be considered for at-risk HSCT recipients. In this cohort, HBV reactivation often developed in patients with cGVHD. Liver biopsy was useful in those patients with both to delineate the contribution of each to liver dysfunction.
在异基因造血干细胞移植（HSCT）受者中，已报告有既往已治愈的乙型肝炎病毒（HBV）感染复发的情况，但其流行病学特征尚未明确。我们对2000年1月至2008年3月期间接受异基因HSCT的既往已治愈HBV感染患者的HBV复发时间及危险因素进行了回顾性评估。HBV复发定义为移植后乙型肝炎表面抗原转为阳性。在移植前既往已治愈HBV感染的61例患者（乙肝核心抗体阳性、乙肝表面抗原阴性）中，12例（19.7%）出现了HBV复发。移植后1年、2年和4年HBV复发的累积概率分别为9.0%、21.7%和42.9%。在时间依赖性Cox模型中，与移植前乙肝表面抗体水平≥10毫国际单位/毫升（mIU/mL）的患者相比，移植前乙肝表面抗体水平<10 mIU/mL的患者HBV复发的校正风险比（HR）为4.56（95%置信区间[CI] 1.23 - 16.9）；与未发生广泛慢性移植物抗宿主病（cGVHD）的患者相比，发生广泛cGVHD的患者校正HR为7.21（95% CI 1.25 - 41.5）。HBV复发是移植前已治愈感染的异基因HSCT受者中常见的晚期并发症。对于有风险的HSCT受者应考虑筛查HBV复发。在该队列中，HBV复发常发生在cGVHD患者中。肝活检对这两类患者均有助于明确各自对肝功能障碍的影响。
