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HBV 相关终末期肝病肝移植后主动免疫对 HBV 移植肝再感染的重建。

Reestablishment of active immunity against HBV graft reinfection after liver transplantation for HBV-related end stage liver disease.

机构信息

Department of Hepatobiliary Surgery and Liver Transplantation Program, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China ; Institute & Hospital of Hepatobiliary Surgery, Key Laboratory of Digital Hepatobiliary Surgery of Chinese PLA, Chinese PLA Medical School, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.

Department of Hepatobiliary Surgery and Liver Transplantation Program, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China.

出版信息

J Immunol Res. 2014;2014:764234. doi: 10.1155/2014/764234. Epub 2014 Dec 17.

DOI:10.1155/2014/764234
PMID:25759834
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4352506/
Abstract

BACKGROUND

The aim of this study was to establish a hepatitis B virus (HBV) vaccination protocol among orthotopic liver transplantation (OLT) recipients under the coverage of a low-dose hepatitis B immunoglobulin (HBIG) combined with an antiviral agent prophylaxis protocol.

METHOD

Two hundred OLT recipients were included in this study. The vaccine was injected at months 0, 1, 2, and 6. Low-dose HBIG combined with antiviral agent prophylaxis protocol was continued before reestablishment of active immunity against HBV in order to maintain a steady anti-HBs titer.

RESULTS

Active immunity against HBV was reestablished in 50 patients, for an overall response rate of 25%. Of the 50 patients, 24 discontinued HBIG without any HBV graft reinfection during a follow-up period of 26.13 ± 7.05 months. 21 patients discontinued both HBIG and antiviral agents during a follow-up period of 39.86 ± 15.47 months, and 4 patients among them appeared to be HBsAg positive. There was no recipient death or graft loss because of HBV reinfection.

CONCLUSIONS

Vaccination preventing HBV reinfection for OLT recipients is feasible. The strategy withdrawal of HBIG with induction of active immunity against hepatitis B is reasonable for long-term survivors of OLT; however, discontinuation nucleoside analogues should be cautious.

摘要

背景

本研究旨在建立一个乙型肝炎病毒（HBV）疫苗接种方案，用于接受原位肝移植（OLT）的患者，方案包括低剂量乙型肝炎免疫球蛋白（HBIG）联合抗病毒药物预防方案。

方法

本研究纳入了 200 名接受 OLT 的患者。疫苗在第 0、1、2 和 6 个月时注射。在重新建立对 HBV 的主动免疫之前，继续使用低剂量 HBIG 联合抗病毒药物预防方案，以维持稳定的抗-HBs 滴度。

结果

50 名患者重新建立了对 HBV 的主动免疫，总体反应率为 25%。在这 50 名患者中，24 名在 26.13±7.05 个月的随访期间停止使用 HBIG 而没有任何 HBV 移植再感染。21 名患者在 39.86±15.47 个月的随访期间同时停止使用 HBIG 和抗病毒药物，其中 4 名患者出现 HBsAg 阳性。没有因 HBV 再感染而导致受者死亡或移植物丢失。

结论

OLT 受者预防 HBV 再感染的疫苗接种是可行的。对于 OLT 的长期幸存者，诱导对乙型肝炎的主动免疫后停用 HBIG 的策略是合理的；然而，停用核苷类似物应该谨慎。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b92f/4352506/5544665288b8/JIR2014-764234.005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b92f/4352506/e2797705b53f/JIR2014-764234.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b92f/4352506/4f19765cfa06/JIR2014-764234.002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b92f/4352506/1da0df4c26c8/JIR2014-764234.003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b92f/4352506/f385006e3409/JIR2014-764234.004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b92f/4352506/5544665288b8/JIR2014-764234.005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b92f/4352506/e2797705b53f/JIR2014-764234.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b92f/4352506/4f19765cfa06/JIR2014-764234.002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b92f/4352506/1da0df4c26c8/JIR2014-764234.003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b92f/4352506/f385006e3409/JIR2014-764234.004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b92f/4352506/5544665288b8/JIR2014-764234.005.jpg

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Prophylaxis against hepatitis B recurrence posttransplantation using lamivudine and individualized low-dose hepatitis B immunoglobulin.肝移植术后应用拉米夫定和个体化小剂量乙型肝炎免疫球蛋白预防乙型肝炎复发。
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The detection of (total and ccc) HBV DNA in liver transplant recipients with hepatitis B vaccine against HBV reinfection.在接受肝移植且接种乙肝疫苗以预防乙肝再感染的患者中检测（总乙肝病毒DNA和共价闭合环状DNA）。
Hum Vaccin Immunother. 2015;11(10):2490-4. doi: 10.1080/21645515.2015.1063755.
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[乙肝病毒感染的肝移植受者患者抗病毒治疗预防病毒复发的长期分析]
Zhonghua Gan Zang Bing Za Zhi. 2007 Sep;15(9):663-6.
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