Darweesh Samar K, Gad Amal A, Akroof Kafya, ElLatif Zainab A
Department of Hepatogastroenterology and Tropical Medicine, Faculty of Medicine, Cairo University, Cairo.
Department of Internal Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
Eur J Gastroenterol Hepatol. 2019 May;31(5):607-612. doi: 10.1097/MEG.0000000000001377.
Although hepatitis B virus (HBV) recurrence after liver transplantation (LTx) has been reduced since the application of the combination of hepatitis B immunoglobulin (HBIG) and nucleos(t)ide analogs (NUCs), the optimum regimen to prevent HBV recurrence with LTx favorable outcome is still not clear.
The aim was to evaluate the efficacy and safety of NUCs prophylaxis (±HBIG) against HBV recurrence after LTx.
This was a retrospective cohort-longitudinal study on 44 HBV-related post-LTx patients on anti-HBV prophylactic therapy. They included the entecavir (ETV)-based (n=34, 30 males) and the other NUC-based (n=10, 7 males) groups±HBIG.
The median age was 63.5 (60-70) years in ETV and 62.5 (55-65) years in other NUCs groups. The mean follow-up duration was 6.09±1.83 years in ETV-based group and 6.3±1.89 years in other NUCs-based group. The mean ETV duration was 3.47±3.04 years. In ETV+HBIG patients, none of them developed HBV recurrence throughout the ±8 years. In the 14 patients on ETV+other NUC+HBIG, four developed HBsAg positive and then transformed to HbsAb positive at the end of ±8 years without hepatitis or detectable HBV-DNA. Liver graft function showed nonsignificant difference for ETV-based patients, in comparison with other NUC groups (P=0.09). With subdivision, the graft function was maintained significantly better in ETV+HBIG or other NUCs+HBIG (P=0.04) groups. None of our patients reported NUCs-related complications or adverse effects.
ETV and other NUCs were effective and safe as a long-term prophylaxis of HBV recurrence after LTx, leading to a good graft function. HBsAg temporally reappeared in a minority of patients, where all showed HBsAb seroconversion without detectable HBV-DNA or clinical hepatitis.
尽管自联合应用乙肝免疫球蛋白（HBIG）和核苷（酸）类似物（NUCs）以来，肝移植（LTx）后乙肝病毒（HBV）复发率有所降低，但能预防HBV复发并获得良好肝移植结局的最佳方案仍不明确。
评估核苷（酸）类似物预防（±HBIG）肝移植后HBV复发的疗效与安全性。
这是一项针对44例接受抗HBV预防性治疗的HBV相关肝移植术后患者的回顾性队列纵向研究。他们包括恩替卡韦（ETV）组（n = 34，30例男性）和其他核苷（酸）类似物组（n = 10，7例男性）±HBIG。
ETV组患者的中位年龄为63.5（60 - 70）岁，其他核苷（酸）类似物组为62.5（55 - 65）岁。基于ETV组的平均随访时间为6.09±1.83年，其他核苷（酸）类似物组为6.3±1.89年。ETV的平均使用时间为3.47±3.04年。在ETV + HBIG患者中，在±8年期间均未发生HBV复发。在14例接受ETV + 其他核苷（酸）类似物 + HBIG治疗的患者中，4例出现HBsAg阳性，随后在±8年末转变为HbsAb阳性，且无肝炎发生或检测不到HBV - DNA。与其他核苷（酸）类似物组相比，基于ETV的患者肝移植功能无显著差异（P = 0.09）。细分来看，ETV + HBIG或其他核苷（酸）类似物 + HBIG组的移植功能维持得明显更好（P = 0.04）。我们的患者均未报告与核苷（酸）类似物相关的并发症或不良反应。
ETV和其他核苷（酸）类似物作为肝移植后HBV复发的长期预防措施有效且安全，可使移植肝功能良好。少数患者中HBsAg会暂时出现，所有这些患者均出现HBsAb血清学转换，且检测不到HBV - DNA或无临床肝炎表现。
