Yamashiki Noriyo, Yoshizawa Atsushi, Ueda Yoshihide, Kaido Toshimi, Okajima Hideaki, Marusawa Hiroyuki, Seno Hiroshi, Uemoto Shinji
Organ Transplantation Unit, Kyoto University Hospital, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Pediatr Transplant. 2018 Aug;22(5):e13227. doi: 10.1111/petr.13227. Epub 2018 May 15.
Prophylactic measures are used to reduce DNHB after HBsAg-negative patients receive anti-HBc-positive liver grafts. This study investigated the incidence of DNHB and clinical outcomes in pediatric LT recipients under HBIG prophylaxis, with or without hepatitis B vaccination. Between 1995 and 2013, 51 HBsAg-negative pediatric recipients underwent living-donor LT from anti-HBc-positive donors. The median (range) age was 4 (0.1-17) years, 23 (45%) were male, and 71% were negative for both anti-HBc and anti-HBc. During a median follow-up of 12.1 (0.06-19.9) years, 13 (25.4%) developed DNHB; 7 of the 13 achieved HBsAg seroconversion after administration of LAM or ETV. Among studied patients, 20 (39%) received hepatitis B vaccination, and 2 of them (10%) developed DNHB. At last follow-up, 41% (21/51) discontinued HBIG either after successful HBV vaccination (n = 17) or retransplantation with anti-HBc-negative grafts (n = 4). In conclusion, pediatric LT recipients of anti-HBc-positive grafts, most of them were naïve to HBV infection, were at high risk of DNHB, and consistent monitoring for the early detection of DNHB was necessary. A combination use of post-LT vaccination is promising prophylactic strategy against DNHB.
在HBsAg阴性患者接受抗-HBc阳性肝移植后，采用预防措施以降低供体隐匿性乙肝病毒（DNHB）感染。本研究调查了在接受乙肝免疫球蛋白（HBIG）预防的儿童肝移植受者中，无论是否接种乙肝疫苗，DNHB的发生率及临床结局。1995年至2013年期间，51例HBsAg阴性的儿童受者接受了来自抗-HBc阳性供体的活体肝移植。中位（范围）年龄为4（0.1 - 17）岁，23例（45%）为男性，71%的受者抗-HBs和抗-HBc均为阴性。在中位随访12.1（0.06 - 19.9）年期间，13例（25.4%）发生了DNHB；其中13例中的7例在给予拉米夫定（LAM）或恩替卡韦（ETV）后实现了HBsAg血清学转换。在研究的患者中，20例（39%）接受了乙肝疫苗接种，其中2例（10%）发生了DNHB。在最后一次随访时，41%（21/51）在成功接种乙肝疫苗（n = 17）或接受抗-HBc阴性移植物再次移植（n = 4）后停用了HBIG。总之，抗-HBc阳性移植物的儿童肝移植受者，其中大多数对乙肝病毒感染无免疫力，发生DNHB的风险很高，因此有必要持续监测以便早期发现DNHB。肝移植后联合使用疫苗接种是预防DNHB的一种有前景的策略。
