Liver Unit, Hospital Clínic, IDIBAPS and CIBERehd, Universitat de Barcelona, Barcelona, Spain.
Liver Unit, CIBERehd, Hospital La Fe, Valencia, Spain.
Liver Int. 2018 Nov;38(11):1940-1950. doi: 10.1111/liv.13858. Epub 2018 May 3.
BACKGROUND & AIMS: The combination of hepatitis B immunoglobulin and a nucleos(t)ide analogues has markedly reduced the rate of hepatitis B virus recurrence after liver transplantation; however, the optimal duration of hepatitis B immunoglobulin has not been clarified. This lack of consensus perpetuates the use of different strategies. The aim of this study was to evaluate the risk factors associated to hepatitis B virus recurrence after liver transplantation in a large cohort of patients under different hepatitis B immunoglobulin regimens.
Retrospective multicentre analysis of hepatitis B virus-related liver transplantation recipients receiving combined prophylaxis (hepatitis B immunoglobulin + nucleos(t)ide analogues). The strategy of short-term hepatitis B immunoglobulin was compared to lifelong administration. Hepatitis B virus recurrence was defined as positive HBsAg after liver transplantation.
Three hundred and thirty-eight patients were analysed. After a median follow-up period of 72 months, 37 patients (11%) developed hepatitis B virus recurrence. Hepatocellular carcinoma recurrence and lamivudine resistance after liver transplantation were the only factors independently associated to hepatitis B virus recurrence (HR 5.4 [2.3-12] and 9.3 [4.2-20] respectively P < .001). HBsAg reappearance after hepatitis B virus recurrence was transient (16 patients), persistent (15) or alternant (6). The hepatitis B immunoglobulin regimen did not have an impact on the rate or evolution of hepatitis B virus recurrence. Overall, patient survival was good and not influenced by hepatitis B virus recurrence (82% at 5 years). Fulminant liver failure, hepatitis C coinfection or hepatocellular carcinoma at liver transplantation were independent risk factors for lower survival.
Liver transplantation is an effective treatment for hepatitis B virus-related liver disease. Since the introduction of combined prophylaxis the rate of hepatitis B virus recurrence is very low. However, lifelong hepatitis B immunoglobulin administration does not seem necessary to reduce hepatitis B virus recurrence.
乙型肝炎免疫球蛋白与核苷（酸）类似物联合应用显著降低了肝移植后乙型肝炎病毒（HBV）复发率；然而，乙型肝炎免疫球蛋白的最佳持续时间尚未阐明。这种缺乏共识导致了不同策略的持续使用。本研究旨在评估不同乙型肝炎免疫球蛋白方案的患者中，与肝移植后 HBV 复发相关的危险因素。
回顾性分析接受联合预防（乙型肝炎免疫球蛋白+核苷（酸）类似物）的乙型肝炎相关肝移植受者的多中心队列研究。将短期乙型肝炎免疫球蛋白策略与终身治疗进行比较。HBV 复发定义为肝移植后 HBsAg 阳性。
共分析了 338 例患者。中位随访 72 个月后，37 例（11%）发生 HBV 复发。肝移植后 HCC 复发和拉米夫定耐药是 HBV 复发的唯一独立相关因素（HR 5.4 [2.3-12] 和 9.3 [4.2-20]，均 P < 0.001）。HBV 复发后 HBsAg 再次出现是短暂的（16 例）、持续的（15 例）或交替的（6 例）。乙型肝炎免疫球蛋白方案对 HBV 复发的发生率或演变无影响。总的来说，患者生存率良好，不受 HBV 复发的影响（5 年时为 82%）。肝移植时发生暴发性肝衰竭、HCV 合并感染或 HCC 是生存率降低的独立危险因素。
肝移植是乙型肝炎相关肝病的有效治疗方法。自联合预防以来，HBV 复发率非常低。然而，终身乙型肝炎免疫球蛋白治疗似乎并不能降低 HBV 复发率。
