Idilman Ramazan, Akyildiz Murat, Keskin Onur, Gungor Gokhan, Yilmaz Tonguc U, Kalkan Cagdas, Dayangac Murat, Cinar Kubilay, Balci Deniz, Hazinedaroglu Selcuk, Tokat Yaman
Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey.
Istanbul Bilim University Faculty of Medicine, Sisli Florence Nightingale Hospital Organ Transplantation Center, Istanbul, Turkey.
Clin Transplant. 2016 Oct;30(10):1216-1221. doi: 10.1111/ctr.12804. Epub 2016 Aug 8.
The aim of this study was to determine the long-term efficacy of nucleos(t)ide analog (NA) and low-dose hepatitis B immunoglobulin (HBIG) combination treatment for preventing post-transplant hepatitis B virus (HBV) recurrence.
A total of 296 patients with HBV-associated liver disease who underwent liver transplantation (LT) were enrolled. A combination of a daily NA and low-dose HBIG was used after LT.
The median follow-up period was 46 months. HBV recurrence occurred in eight patients. The cumulative probability of HBV recurrence at 1, 3, 5, and 7 years was 1%, 3%, 3%, and 4%, respectively. Seven were on lamivudine (LMV) or adefovir dipivoxil (ADV), or LMV and ADV and HBIG combination treatment and one entecavir (ETV) and HBIG. With Cox regression analysis, HBV recurrence was determined to be associated with the presence of hepatocellular cancer (HCC) prior to LT (HR: 12.3, P=.02). Overall, 44 patients died. Survival was significantly better in the ETV or tenofovir disoproxil fumarate (TDF) and HBIG group than the other group (P<.001).
The combination of ETV or TDF and low-dose HBIG achieved a more favorable prophylaxis against HBV recurrence after LT. The presence of HCC prior to LT was associated with post-transplant HBV recurrence.
本研究旨在确定核苷（酸）类似物（NA）与小剂量乙型肝炎免疫球蛋白（HBIG）联合治疗预防肝移植后乙型肝炎病毒（HBV）复发的长期疗效。
共纳入296例接受肝移植（LT）的HBV相关肝病患者。肝移植后采用每日NA与小剂量HBIG联合治疗。
中位随访期为46个月。8例患者发生HBV复发。1年、3年、5年和7年HBV复发的累积概率分别为1%、3%、3%和4%。7例接受拉米夫定（LMV）或阿德福韦酯（ADV），或LMV与ADV及HBIG联合治疗，1例接受恩替卡韦（ETV）及HBIG治疗。通过Cox回归分析，确定HBV复发与肝移植前存在肝细胞癌（HCC）有关（HR：12.3，P = 0.02）。总体而言，44例患者死亡。ETV或替诺福韦酯（TDF）及HBIG组的生存率显著高于其他组（P < 0.001）。
ETV或TDF与小剂量HBIG联合使用在预防肝移植后HBV复发方面取得了更有利的效果。肝移植前存在HCC与移植后HBV复发有关。
