Pediatric Research Institute, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China.
Institute for Viral Hepatitis, Ministry of Education Key Laboratory of Molecular Biology On Infectious Diseases, Chongqing Medical University, Chongqing, People's Republic of China.
Hepatol Int. 2020 Mar;14(2):202-211. doi: 10.1007/s12072-020-10021-5. Epub 2020 Feb 25.
There is an increased awareness of de novo hepatitis B virus (HBV) infection (DNH) in hepatitis B surface antigen (HBsAg)-negative recipients receiving hepatitis B core antibody (HBcAb)-positive liver organ. Whether hepatitis B surface antibody (HBsAb) has positive result on preventing the occurrence of DNH in HBcAb-positive liver graft recipients remains unknown. A meta-analysis was conducted to evaluate the effect of HBsAb on DNH in these patients.
We sought published studies through August 29, 2019, in Medline and other sources that examined DNH in liver transplantation receptors with HBcAb-positive grafts. The rate of DNH was established in random-effects model meta-analyses.
In 36 studies involving 950 patients, the pooled incidence rate of DNH was 5% in patients with HBsAb positive versus 28.0% HBsAb negative. Prophylactic treatment has a significant impact on the occurrence of DNH in HBsAb-negative patients, no difference in hepatitis B immunoglobulin-combined and nucleos(t)ide analogues (NAs)-alone immunoprophylaxis. Unprotected HBV-naïve patients had the highest risk with DNH.
Immunoprophylaxis may need more consideration for HBsAb-positive patients receiving HBcAb-positive liver grafts. Active vaccination and mono-prophylaxis with NAs could be recommended in HBsAb-negative recipients against DNH. Further studies should examine the higher genetic barrier drugs for preventing DNH, and the association between DNH and HBV DNA-positive liver graft in this patient population.
在接受乙型肝炎核心抗体（HBcAb）阳性肝脏的乙型肝炎表面抗原（HBsAg）阴性受者中，人们越来越意识到新发生的乙型肝炎病毒（HBV）感染（DNH）。HBcAb 阳性肝移植物受者中 HBsAb 是否阳性对预防 DNH 的发生尚不清楚。进行了一项荟萃分析，以评估 HBsAb 对这些患者 DNH 的影响。
我们通过 Medline 和其他来源检索了截至 2019 年 8 月 29 日发表的研究，这些研究检查了 HBcAb 阳性移植物受体中 DNH 的发生。在随机效应模型荟萃分析中确定了 DNH 的发生率。
在 36 项涉及 950 例患者的研究中，HBsAb 阳性患者的 DNH 累积发生率为 5%，而 HBsAb 阴性患者为 28.0%。预防治疗对 HBsAb 阴性患者 DNH 的发生有显著影响，HBV 免疫球蛋白联合与核苷（酸）类似物（NAs）单独免疫预防无差异。无保护的 HBV 初治患者发生 DNH 的风险最高。
HBcAb 阳性肝移植物受者的 HBsAb 阳性患者可能需要更多地考虑免疫预防。对于 HBsAb 阴性的受者，主动免疫接种和 NAs 单药预防可能有助于预防 DNH。进一步的研究应检查预防 DNH 的更高遗传屏障药物，以及该患者人群中 DNH 与 HBV DNA 阳性肝移植物的关系。
