Kasraianfard Amir, Watt Kymberly D, Lindberg Lance, Alexopoulos Sophoclis, Rezaei Nima
a Hepatobiliary and Liver Transplantation Research Center, Tehran University of Medical Sciences , Tehran , Iran.
b Division of Gastroenterology and Hepatology, Mayo Clinic and Foundation , Rochester , MN , USA.
Int Rev Immunol. 2016 Jul 3;35(4):312-324. doi: 10.3109/08830185.2014.921160. Epub 2014 Jun 9.
Advent of hepatitis B immunoglobulin (HBIG) as the mainstay of prophylaxis against hepatitis B recurrence after liver transplantation with antiviral drugs has resulted in excellent outcomes for liver transplantation in hepatitis B virus (HBV)-related cirrhosis in the last two decades. However, there is no consensus on a gold standard prophylaxis protocol and several controversies over the duration, dose, and route of administration of HBIG with or without different antivirals exist among liver transplantation centers. We present this review of different prophylaxis regimens including HBIG and antiviral monotherapy, combination of HBIG with antivirals, and withdrawal of HBIG and whole prophylaxis. HBIG monotherapy in either the intramuscular or the subcutaneous form is an accepted choice for prevention of HBV re-infection after liver transplantation in low risk patients. Withdrawal of HBIG monotherapy may be considered but should only occur after transitioning to an oral antiviral therapy such as adefovir, tenofovir, or entecavir. Lamivudine monotherapy may be associated with a higher recurrence rate compared to more potent antivirals. In high risk patients, intramuscular or subcutaneous HBIG in combination with an antiviral, most commonly lamivudine, is currently considered the standard of care. Complete discontinuation of all preventative therapy cannot be recommended at this time and should only be performed in the setting of a clinical trial.
在过去二十年中，乙肝免疫球蛋白（HBIG）联合抗病毒药物成为预防肝移植术后乙肝复发的主要手段，这使得乙肝病毒（HBV）相关肝硬化患者的肝移植取得了优异的治疗效果。然而，对于预防乙肝复发的金标准方案尚未达成共识，各肝移植中心对于HBIG联合或不联合不同抗病毒药物的使用疗程、剂量及给药途径存在诸多争议。我们在此综述不同的预防方案，包括HBIG单药治疗、抗病毒单药治疗、HBIG与抗病毒药物联合治疗以及停用HBIG和全程预防。对于低风险患者，肌肉注射或皮下注射HBIG单药治疗是预防肝移植术后HBV再感染的一种可接受的选择。可考虑停用HBIG单药治疗，但仅应在过渡到口服抗病毒治疗（如阿德福韦、替诺福韦或恩替卡韦）后进行。与更有效的抗病毒药物相比，拉米夫定单药治疗可能与更高的复发率相关。对于高风险患者，目前认为肌肉注射或皮下注射HBIG联合抗病毒药物（最常用的是拉米夫定）是标准治疗方案。目前不建议完全停用所有预防性治疗，仅应在临床试验的背景下进行。
