Nassiri-Toosi Mohssen, Kasraianfard Amir, Ahmadinejad Zahra, Dashti Habibollah, Moini Majıd, Najafi Atabak, Salimi Javad, Jafarian Ali
From the Department of Gastroenterology-Hepatology, Tehran University of Medical Sciences, Tehran, Iran.
Exp Clin Transplant. 2015 Apr;13 Suppl 1:127-32.
Hepatitis B immunoglobulin prophylaxis in combination with antiviral drugs is recommended for prevention of hepatitis B virus reinfection after liver transplant. However, there is no consensus on a standard prophylactic method, and controversy exists over the duration, dose, and route of administration. We conducted a prospective study to evaluate the safety and effectiveness of intramuscular hepatitis B immunoglobulin in combination with lamivudine and/or tenofovir and discontinuation of hepatitis B immunoglobulin after 1 year for prevention of hepatitis B virus reinfection.
Patients with hepatitis Brelated liver cirrhosis who had undergone primary liver transplants were enrolled. The prophylactic protocol involved intraoperative intramuscular hepatitis B immunoglobulin at 10 000 IU, tapering to 5000 IU daily for the first 6 days, weekly for a month, every 2 weeks for the next month, and monthly for a year after liver transplant, in combination with antiviral drugs.
From January 2002 until March 2014, two hundred sixty-eight liver transplants were performed. Forty-four patients (16.4%) who underwent liver transplants due to hepatitis B-related liver failure were enrolled. Five patients had hepatocellular carcinoma; 20 had both hepatitis D and hepatitis B virus infection. The median age was 47 years (range, 26-59 y) with a median model for end stage liver disease score of 20. Thirty-three patients were men (76%). Sixty-one percent of patients were negative for hepatitis B virus DNA at the time of transplant. The median follow-up was 13.6 months (range, 0-142 mo). Only 1 patient (2.3%) experienced hepatitis B virus reinfection (at 44.7 months posttransplant), which was successfully treated with tenofovir. Five patients died (11.4%) during the follow-up from nonhepatitis B causes.
Intramuscular hepatitis B immunoglobulin in combination with lamivudine or tenofovir and discontinuation of hepatitis B immunoglobulin after 1 year posttransplant may provide safe and cost-effective protection against posttransplant hepatitis B reinfection.
推荐使用乙肝免疫球蛋白联合抗病毒药物预防肝移植术后乙肝病毒再感染。然而，对于标准预防方法尚无共识，在用药持续时间、剂量和给药途径方面存在争议。我们进行了一项前瞻性研究，以评估肌肉注射乙肝免疫球蛋白联合拉米夫定和/或替诺福韦，并在1年后停用乙肝免疫球蛋白预防乙肝病毒再感染的安全性和有效性。
纳入因乙肝相关肝硬化接受初次肝移植的患者。预防方案包括术中肌肉注射10000IU乙肝免疫球蛋白，术后第1个6天每天减至5000IU，接下来1个月每周注射，再接下来1个月每2周注射，肝移植术后1年每月注射，同时联合抗病毒药物。
从2002年1月至2014年3月，共进行了268例肝移植手术。44例（16.4%）因乙肝相关肝衰竭接受肝移植的患者被纳入研究。5例患者患有肝细胞癌；20例同时感染丁型肝炎病毒和乙肝病毒。中位年龄为47岁（范围26 - 59岁），终末期肝病模型评分中位数为20。33例患者为男性（76%）。61%的患者在移植时乙肝病毒DNA呈阴性。中位随访时间为13.6个月（范围0 - 142个月）。仅1例患者（2.3%）发生乙肝病毒再感染（移植后44.7个月），使用替诺福韦成功治疗。5例患者（11.4%）在随访期间因非乙肝原因死亡。
肌肉注射乙肝免疫球蛋白联合拉米夫定或替诺福韦，并在移植后1年停用乙肝免疫球蛋白，可能为预防移植后乙肝再感染提供安全且具有成本效益的保护。
