Cholongitas Evangelos, Goulis Ioannis, Antoniadis Nikolaos, Fouzas Ioannis, Imvrios George, Papanikolaou Vasilios, Akriviadis Evangelos
4th Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece.
Transpl Int. 2014 Oct;27(10):1022-8. doi: 10.1111/tri.12370. Epub 2014 Jun 30.
New nucleos(t)ide agents (NAs) [entecavir (ETV) and tenofovir (TDF)] have made hepatitis B immunoglobulin (HBIG)-sparing protocols an attractive approach against hepatitis B virus (HBV) recurrence after liver transplantation (LT). Twenty-eight patients transplanted for HBV cirrhosis in our centre were prospectively evaluated. After LT, each patient received HBIG (1000 IU IM/day for 7 days and then monthly for 6 months) plus ETV or TDF and then continued with ETV or TDF monoprophylaxis. All patients had undetectable HBV DNA at the time of LT, and they were followed up with laboratory tests including glomerular filtration rate (GFR) after LT. All patients (11 under ETV and 17 under TDF) remained HBsAg/HBV DNA negative during the follow-up period [median: 21 (range 9-43) months]. GFR was not different between TDF and ETV groups of patients at 6 and 12 months and last follow-up (P value >0.05 for all comparisons). The two groups of patients were similar regarding their ratio of maximum rate of tubular phosphate reabsorption to the GFR (TmP/GFR). In conclusion, in this prospective study, we showed for the first time that maintenance therapy with ETV or TDF monoprophylaxis after 6 months of low-dose HBIG plus ETV or TDF after LT is highly effective and safe.
新型核苷（酸）类似物（NAs）[恩替卡韦（ETV）和替诺福韦（TDF）]使不使用乙肝免疫球蛋白（HBIG）的方案成为肝移植（LT）后预防乙肝病毒（HBV）复发的一种有吸引力的方法。我们中心对28例因HBV肝硬化接受移植的患者进行了前瞻性评估。LT后，每位患者接受HBIG（1000 IU，肌肉注射，每天1次，共7天，然后每月1次，共6个月）加ETV或TDF，然后继续使用ETV或TDF进行单药预防治疗。所有患者在LT时HBV DNA均检测不到，LT后通过包括肾小球滤过率（GFR）在内的实验室检查进行随访。所有患者（11例接受ETV治疗，17例接受TDF治疗）在随访期间（中位数：21个月，范围9 - 43个月）HBsAg/HBV DNA均为阴性。在6个月、12个月及最后一次随访时，TDF组和ETV组患者的GFR无差异（所有比较的P值均>0.05）。两组患者的肾小管磷重吸收率与GFR之比（TmP/GFR）相似。总之，在这项前瞻性研究中，我们首次表明，LT后低剂量HBIG加ETV或TDF治疗6个月后，继续使用ETV或TDF进行单药预防治疗是高度有效且安全的。
