Division of Infectious and Parasitic Diseases, Clinics Hospital Department of Infectious and Parasitic Diseases, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Clin Transplant. 2010 Nov-Dec;24(6):735-46. doi: 10.1111/j.1399-0012.2010.01254.x.
After liver transplant (LT) from Anti-HBc+/HBsAg- donors into HBsAg- recipients, transmission of hepatitis B virus (HBV) may occur (de novo HBV infection). This study analyzes the incidence of de novo HBV infection in HBsAg- recipients of Anti-HBc+/HBsAg- LT with respect to: (i) the recipients' HBV serology and (ii) the type of preventive therapy adopted.
A systematic review of the literature using the electronic database Medline.
Five hundred and fifty-two LT in 36 articles were selected. Lamivudine, Hepatitis B immune globulin (HBIG), revaccination, and combined therapies were employed in multiple strategies as preventive interventions. Naïve recipients had a high risk of de novo HBV infection, with smaller incidences when HBIG and lamivudine were used, either alone or in association. Vaccinated recipients or those with isolated hepatitis B core antibodies (Anti-HBc) and previous HBV infection had lower risks of viral transmission, additionally reduced by any prophylaxis adoption.
LT from Anti-HBc+/HBsAg- donors into HBsAg- recipients is apparently safe, as long as the recipient is vaccinated or presents an isolated Anti-HBc or previous HBV infection and some prophylaxis is employed. Currently lamivudine seems the best alternative; other nucleoside analogs and revaccination strategies should be considered in future studies. Follow-up and preventive therapies should be maintained for five yr or preferably throughout the recipients' life span.
在抗-HBc+/HBsAg-供体向 HBsAg-受者进行肝移植（LT）后，可能会发生乙型肝炎病毒（HBV）的传播（新发生的 HBV 感染）。本研究分析了抗-HBc+/HBsAg- LT 中 HBsAg-受者发生新发生 HBV 感染的发生率，具体取决于：（i）受者的 HBV 血清学和（ii）采用的预防治疗类型。
使用电子数据库 Medline 进行系统文献回顾。
从 36 篇文章中选择了 552 例 LT。拉米夫定、乙型肝炎免疫球蛋白（HBIG）、再接种和联合治疗被用于多种策略作为预防干预。HBIG 和拉米夫定单独或联合使用时，HBV 疫苗接种的受者或仅具有乙型肝炎核心抗体（Anti-HBc）和既往 HBV 感染的受者发生新发生 HBV 感染的风险较高。任何预防措施的采用都可以降低病毒传播的风险。
只要受者接种疫苗或具有单独的 Anti-HBc 或既往 HBV 感染并且采用一些预防措施，从抗-HBc+/HBsAg-供体向 HBsAg-受者进行 LT 显然是安全的。目前拉米夫定似乎是最佳选择；其他核苷类似物和再接种策略应在未来的研究中考虑。应进行 5 年或最好是受者整个生命周期的随访和预防治疗。
