Division of Hematology, SGB Hospital, University of Torino, Torino, Italy.
Biol Blood Marrow Transplant. 2010 Jun;16(6):809-17. doi: 10.1016/j.bbmt.2009.12.533. Epub 2010 Jan 7.
Patients previously infected with hepatitis B virus (HBV) undergoing an allograft and recipients from HBV carrier donors are at risk of posttransplant viral reactivation. The role of prophylaxis with lamivudine remains unclear. One hundred seventeen patients, with a median age of 52 years (20-67 years), with various hematologic malignancies transplanted between 1999 and 2007 entered the study. Eighty-seven recipients negative for HBV surface antigen (HBsAg), antihepatitis B core antigen antibodies (anti-HBc), and HBV-DNA with HBsAg and HBV-DNA negative donors were defined as at low risk of HBV reactivation, whereas all the remaining 30 patients were defined as at high risk. Patients at high risk transplanted in 2005 or after received lamivudine to prevent HBV reactivation as per the Italian guidelines by the Associazione Italiana per lo Studio del Fegato (AISF). Patients at low risk did not experience HBV reactivation/hepatitis. Among the recipients at high risk, 11 of 25 anti-HBc positive, those HBsAg positive (2 of 2) or negative but transplanted from HBsAg positive donors (3 of 3) were treated with lamivudine. None of these developed HBV reactivation/hepatitis after a median follow-up of 40 months (17-55 months). Hepatitis developed in 3 anti-HBc positive untreated patients conditioned with a reduced-intensity regimen. Hepatitis B was not observed in recipients at low risk, transplanted from HBsAg negative/anti-HBc positive or negative donors. Lamivudine was effective in controlling reactivation in: HBsAg positive recipients, in patients transplanted from HBsAg positive donors and in HBsAg negative/antiHBc positive recipients, who showed a significant risk of reactivation if not given prophylaxis (NCT 00876148).
先前感染过乙型肝炎病毒 (HBV) 的患者进行同种异体移植，且受体来自 HBV 携带者供体，这些患者存在移植后病毒再激活的风险。使用拉米夫定进行预防的作用仍不清楚。本研究共纳入 117 例中位年龄为 52 岁（20-67 岁）的各种血液系统恶性肿瘤患者，这些患者于 1999 年至 2007 年间接受了移植。87 例受体 HBV 表面抗原 (HBsAg)、抗乙型肝炎核心抗原抗体 (抗-HBc) 和 HBV-DNA 均为阴性，且 HBsAg 和 HBV-DNA 阴性的供体被定义为 HBV 再激活的低危患者，而其余 30 例患者则被定义为高危患者。2005 年或之后按照意大利肝脏研究协会 (AISF) 的意大利指南，接受拉米夫定预防 HBV 再激活治疗的高危患者移植。低危患者未发生 HBV 再激活/肝炎。在 25 例抗-HBc 阳性的高危患者中，2 例 HBsAg 阳性（2 例）或 HBsAg 阴性但来自 HBsAg 阳性供体的患者（3 例）接受了拉米夫定治疗。在中位随访 40 个月（17-55 个月）后，这些患者均未发生 HBV 再激活/肝炎。3 例未接受治疗、采用低强度预处理方案的抗-HBc 阳性患者出现了肝炎。在来自 HBsAg 阴性/抗-HBc 阳性或阴性供体的低危患者中未观察到乙型肝炎。拉米夫定在以下患者中有效控制了再激活：HBsAg 阳性的患者、来自 HBsAg 阳性供体的患者和 HBsAg 阴性/抗-HBc 阳性的患者，如果不进行预防，这些患者存在显著的再激活风险（NCT 00876148）。
