韩国肝移植术后乙型肝炎预防：KOTRY 数据库分析。
Hepatitis B Prophylaxis after Liver Transplantation in Korea: Analysis of the KOTRY Database.
机构信息
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
出版信息
J Korean Med Sci. 2020 Feb 17;35(6):e36. doi: 10.3346/jkms.2020.35.e36.
BACKGROUND
Prophylaxis for hepatitis B virus (HBV) recurrence is essential after liver transplantation (LT) in HBV-associated recipients. We conducted real-world analysis of HBV prophylaxis after LT in the Korean population.
METHODS
Korean Organ Transplantation Registry (KOTRY) database and additionally collected data (n = 326) were analyzed with special reference to types of HBV prophylaxis.
RESULTS
The study cohort comprised 267 cases of living-donor LT and 59 cases of deceased-donor LT. Hepatocellular carcinoma (HCC) was diagnosed in 232 (71.2%) of these subjects. Antiviral agents were used in 255 patients (78.2%) prior to LT. HBV DNA was undetectable in 69 cases (21.2%) and detectable over wide concentrations in the other 257 patients (78.8%) prior to LT. Polymerase chain reaction analysis of the store blood samples detected HBV DNA in all patients, with 159 patients (48.9%) showing concentrations > 100 IU/mL. Post-transplant HBV regimens during the first year included combination therapy in 196 (60.1%), hepatitis B immunoglobulin (HBIG) monotherapy in 121 (37.1%), and antiviral monotherapy in 9 (2.8%). In the second post-transplant year, these regimens had changed to combination therapy in 187 (57.4%), HBIG monotherapy in 112 (34.4%), and antiviral monotherapy in 27 (8.3%). Trough antibody to hepatitis B surface antigen titers > 500 IU/mL and >1,000 IU/mL were observed in 61.7% and 25.2%, respectively. The mean simulative half-life of HBIG was 21.6 ± 4.3 days with a median 17.7 days. Up to 2-year follow-up period, HCC recurrence and HBV recurrence developed in 18 (5.5%) and 6 (1.8%), respectively. HCC recurrence developed in 3 of 6 patients with HBV recurrence.
CONCLUSION
Combination therapy is the mainstay of HBV prophylaxis protocols in a majority of Korean LT centers, but HBIG was often administered excessively. Individualized optimization of HBIG treatments using SHL is necessary to adjust the HBIG infusion interval.
背景
在乙型肝炎病毒（HBV）相关受者进行肝移植（LT）后，预防 HBV 复发至关重要。我们对韩国人群中 LT 后 HBV 预防进行了真实世界分析。
方法
对韩国器官移植登记处（KOTRY）数据库和额外收集的数据（n=326）进行了分析，特别参考了 HBV 预防的类型。
结果
研究队列包括 267 例活体供者 LT 和 59 例死体供者 LT。232 例（71.2%）患者诊断为肝细胞癌（HCC）。255 例患者在 LT 前使用了抗病毒药物（78.2%）。69 例患者（21.2%）在 LT 前 HBV DNA 不可检测，而其他 257 例患者（78.8%）HBV DNA 浓度广泛可检测。对所有患者的储存血样进行聚合酶链反应分析均检测到 HBV DNA，其中 159 例患者（48.9%）浓度>100 IU/mL。移植后第一年的 HBV 方案包括联合治疗 196 例（60.1%）、乙肝免疫球蛋白（HBIG）单药治疗 121 例（37.1%）和抗病毒单药治疗 9 例（2.8%）。在移植后的第二年，这些方案在 187 例（57.4%）中转变为联合治疗，112 例（34.4%）为 HBIG 单药治疗，27 例（8.3%）为抗病毒单药治疗。观察到抗乙型肝炎表面抗原抗体的血清浓度>500 IU/mL 和>1000 IU/mL 分别为 61.7%和 25.2%。HBIG 的平均模拟半衰期为 21.6±4.3 天，中位数为 17.7 天。在 2 年的随访期间，分别有 18 例（5.5%）和 6 例（1.8%）发生 HCC 复发和 HBV 复发。HBV 复发的 6 例患者中有 3 例发生 HCC 复发。
结论
在大多数韩国 LT 中心，联合治疗是 HBV 预防方案的主要方法，但 HBIG 常被过度使用。使用 SHL 对 HBIG 治疗进行个体化优化以调整 HBIG 输注间隔是必要的。
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