Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
Am J Transplant. 2010 Aug;10(8):1861-9. doi: 10.1111/j.1600-6143.2010.03208.x.
Although the combination of lamivudine (LAM) and high-dose intravenous (IV) hepatitis B immunoglobulin (HBIG) is very effective in preventing hepatitis B virus (HBV) recurrence after liver transplantation (LT), the major limitation of this regimen is its high cost. A more cost-effective, convenient and widely accepted regimen is urgently needed. We evaluated the safety and efficacy of another strategy using LAM and individualized low-dose intramuscular (IM) HBIG. Between May 2002 and December 2009, a total of 254 adult patients undergoing LT for HBV-related benign end-stage liver diseases received this regimen in our center. The mean follow-up of these patients was 41.2 +/- 22.7 months. Their 1-, 3- and 5-year survival rates were 85.3%, 77.4% and 76.4%, respectively, and 1-, 3- and 5-year HBV recurrence rates were 2.3%, 6.2% and 8.2%. Fourteen patients experienced posttransplant HBV recurrence. Pretransplant high viral load and posttransplant prednisone withdrawal time were observed to be associated with recurrence. In conclusion, combination therapy with LAM and individualized low-dose IM HBIG provides a safe and effective prophylaxis against HBV recurrence after LT at about 5% of the cost of conventional high-dose IV HBIG regimens.
虽然拉米夫定（LAM）和高剂量静脉（IV）乙型肝炎免疫球蛋白（HBIG）的联合应用在预防肝移植（LT）后乙型肝炎病毒（HBV）复发方面非常有效，但该方案的主要限制是其成本高。迫切需要一种更具成本效益、方便且广泛接受的方案。我们评估了另一种使用 LAM 和个体化低剂量肌内（IM）HBIG 的策略的安全性和有效性。2002 年 5 月至 2009 年 12 月，我们中心共有 254 例因乙型肝炎相关良性终末期肝病接受 LT 的成年患者接受了该方案。这些患者的平均随访时间为 41.2 +/- 22.7 个月。他们的 1 年、3 年和 5 年生存率分别为 85.3%、77.4%和 76.4%，1 年、3 年和 5 年 HBV 复发率分别为 2.3%、6.2%和 8.2%。14 例患者发生移植后 HBV 复发。观察到移植前高病毒载量和移植后泼尼松停药时间与复发有关。总之，LAM 和个体化低剂量 IM HBIG 联合治疗为 LT 后 HBV 复发提供了一种安全有效的预防措施，其成本约为传统高剂量 IV HBIG 方案的 5%。
