Varghese Joy, Reddy Mettu Srinivas, Cherian Thomas, Vijaya Srinivasan, Jayanthi Venkataraman, Rela Mohamed
Department of Hepatology and Liver Transplantation, Global Hospitals and Health City, Perumbakkam, Chennai, 600 100, India,
Indian J Gastroenterol. 2014 May;33(3):226-30. doi: 10.1007/s12664-014-0457-z. Epub 2014 Apr 24.
Hepatitis B virus (HBV) recurrence after a liver transplant (LT) is a global issue. Several strategies have been adopted to prevent this recurrence. Most strategies recommend a combination of hepatitis B immunoglobulin (HBIG) and or nucleos(t)ide analogue.
The aim of the study is to determine the anti-HBs response to HBIG among Indian patients who had undetectable pre-transplant HBV DNA.
Seven adult HBV-related LT recipients of Indian origin with low pre-transplant HBV titres who had a liver transplant between August 2009 and June 2012 were included in the study. The protocol followed for post-liver transplant HBIG dose was titrated to achieve an anti-HBs titre of at least 100 IU/L. All recipients were on entecavir. Anti-HBs titre, and HBsAg status was checked at regular intervals. A retrospective analysis of the anti-HBs response to a loading and maintenance dose of HBIG was done.
Seven adult HBV-related LT recipients on post-transplant prophylaxis with HBIG and nucleoside analogue (entecavir) fulfilled the criteria for the study. The median anti-HBs response to the anhepatic and loading dose of HBIG was high at 555 IU/L. In two, the response was less than 100 IU/L. The median dose of HBIG reduced at end of 1 month to 800 IU, and the median titre was 223 IU/L. For the next 11 months, the median requirement of HBIG was 3,000 and 4,000 IU, and the titre was low at 53.8 and 60.9 IU/L at end of 6 and 12 months, respectively.
The anti-HBs response to HBIG was variable, and titres even below 100 IU/L did not result in HBV recurrence when HBIG was given in combination with entecavir.
肝移植（LT）后乙肝病毒（HBV）复发是一个全球性问题。已采用多种策略来预防这种复发。大多数策略推荐联合使用乙肝免疫球蛋白（HBIG）和/或核苷（酸）类似物。
本研究的目的是确定移植前HBV DNA检测不到的印度患者对HBIG的抗-HBs反应。
纳入2009年8月至2012年6月期间进行肝移植的7例印度裔成年HBV相关肝移植受者，这些受者移植前HBV滴度较低。肝移植后HBIG剂量遵循的方案进行滴定，以达到至少100 IU/L的抗-HBs滴度。所有受者均服用恩替卡韦。定期检查抗-HBs滴度和HBsAg状态。对HBIG负荷剂量和维持剂量的抗-HBs反应进行回顾性分析。
7例接受HBIG和核苷类似物（恩替卡韦）移植后预防的成年HBV相关肝移植受者符合研究标准。对无肝期和HBIG负荷剂量的抗-HBs反应中位数较高，为555 IU/L。其中2例反应低于100 IU/L。1个月末HBIG的中位数剂量降至800 IU，中位数滴度为223 IU/L。在接下来的11个月中，HBIG的中位数需求量为3000和4000 IU，6个月末和12个月末的滴度分别较低，为53.8和60.9 IU/L。
对HBIG的抗-HBs反应存在差异，当HBIG与恩替卡韦联合使用时，即使滴度低于100 IU/L也不会导致HBV复发。
