Malik Mohammad U, Ucbilek Enver, Trilianos Panagiotis, Cameron Andrew M, Gurakar Ahmet
>From the Division of Gastroenterology and Hepatology, Transplant Hepatology, Johns Hopkins Hospital School of Medicine, Baltimore, Maryland, USA.
Exp Clin Transplant. 2017 Apr;15(2):183-188. doi: 10.6002/ect.2015.0277. Epub 2016 May 17.
Hepatitis B core antibody immunoglobulin G seropositivity is evidence of past exposure to hepatitis B virus. Donor or recipient hepatitis B core antibody positivity may pose a risk of reactivation, especially early after liver transplant. Although most centers advocate using antiviral agents plus hepatitis B immunoglobulin, some have recently relied on antivirals only as prophylaxis after liver transplant. Here, we retrospectively investigated patient survival in hepatitis B core antibody-positive recipients, comparing those treated with antivirals plus hepatitis B immunoglobulin versus antivirals alone.
After Internal Review Board approval, we reviewed medical records of deceased-donor liver transplant recipients between 1995 and 2013. Demographic characteristics, transplant indication, hepatitis B core antibody status, time to death, and type of posttransplant prophylaxis were recorded. We also recorded whether donors showed hepatitis B core antibody positivity. Patients who died within 30 days of liver transplant were excluded.
There were 148 hepatitis B core antibody-positive recipients. Prophylaxis was given to 75 recipients after transplant: 8 (5%) received hepatitis B immunoglobulin, 22 (15%) received antivirals, and 45 (30%) received the combination. There were 34 deaths: 3 (38%) in hepatitis B immunoglobulin only, 3 (14%) in antiviral only, 8 (18%) in the combination, and 20 (27%) in no prophylaxis groups. One- and 5-year survival rates were similar for binary comparisons among prophylaxis groups (P > .05).
Preliminary results support the current practice of using hepatitis B immunoglobulin plus antivirals for prophylaxis after liver transplant. The similar survival benefit with the combination versus antiviral agents alone suggests equal effectivity for prophylaxis posttransplant. However, a clear benefit of antivirals was not evident in our analysis. Future larger prospective studies are warranted to identify potential benefits of using antivirals alone as prophylaxis after liver transplant and to further clarify their role as the sole prophylactic regimen.
乙肝核心抗体免疫球蛋白G血清学阳性是既往接触过乙肝病毒的证据。供体或受体乙肝核心抗体阳性可能带来再激活风险，尤其是在肝移植术后早期。尽管大多数中心主张使用抗病毒药物加乙肝免疫球蛋白，但最近一些中心仅依靠抗病毒药物作为肝移植后的预防措施。在此，我们回顾性调查了乙肝核心抗体阳性受体的患者生存率，比较了接受抗病毒药物加乙肝免疫球蛋白治疗的患者与仅接受抗病毒药物治疗的患者。
经内部审查委员会批准后，我们查阅了1995年至2013年间已故供体肝移植受者的病历。记录人口统计学特征、移植指征、乙肝核心抗体状态、死亡时间和移植后预防类型。我们还记录了供体是否显示乙肝核心抗体阳性。排除肝移植术后30天内死亡的患者。
有148名乙肝核心抗体阳性受体。75名受体在移植后接受了预防措施：8名（5%）接受了乙肝免疫球蛋白，22名（15%）接受了抗病毒药物，45名（30%）接受了联合治疗。有34例死亡：仅接受乙肝免疫球蛋白治疗的患者中有3例（38%）死亡，仅接受抗病毒药物治疗的患者中有3例（14%）死亡，接受联合治疗的患者中有8例（18%）死亡，未接受预防措施组中有20例（27%）死亡。预防措施组之间的二元比较中，1年和5年生存率相似（P>.05）。
初步结果支持目前肝移植后使用乙肝免疫球蛋白加抗病毒药物进行预防的做法。联合治疗与单独使用抗病毒药物的生存获益相似，表明移植后预防效果相同。然而，在我们的分析中，抗病毒药物的明显益处并不明显。未来有必要进行更大规模的前瞻性研究，以确定单独使用抗病毒药物作为肝移植后预防措施的潜在益处，并进一步阐明其作为唯一预防方案的作用。
