Division of Gastroenterology and Hepatology, Department of Medicine, NYU School of Medicine, NYU Langone Health, New York, NY, USA.
NYU Langone Transplant Institute, NYU Langone Health, New York, NY, USA.
Aliment Pharmacol Ther. 2020 Sep;52(6):944-954. doi: 10.1111/apt.15999. Epub 2020 Aug 3.
A critical aspect of liver transplantation in hepatitis B patients is to prevent graft reinfection with hepatitis B virus. The use of hepatitis B immune globulin after transplant was a significant milestone, which allowed prolonged graft and patient survival by controlling hepatitis B reinfection in liver grafts. The development of anti-viral treatments with oral nucleos(t)ide analogues, led to a further reduction in graft reinfection and improvement in patient survival. The combination of the aforementioned two therapies has been widely used in hepatitis B-associated liver transplants.
To address the post-transplant management of hepatitis B and provide updates on preventing graft reinfection.
We performed a literature search on Ovid and PubMed for randomised controlled trials or cohort studies in English, which investigated the effectiveness of hepatitis B immune globulin and anti-viral therapy on hepatitis B-associated transplants (1/2000-1/2020). Studies that met pre-established criteria were reviewed.
Based on currently available evidence, an algorithm for post-transplant management with anti-viral therapy is proposed. Also, the management of recipients who received grafts from hepatitis B core antibody-positive donors is discussed.
The development of hepatitis B immune globulin and anti-viral treatments led to substantial improvement in graft and patient survival. The prevention of hepatitis B graft reinfection is complex and involves a broad interdisciplinary team.
乙型肝炎患者肝移植的一个关键方面是防止移植物再次感染乙型肝炎病毒。移植后使用乙型肝炎免疫球蛋白是一个重要的里程碑，通过控制肝移植中乙型肝炎的再感染，延长了移植物和患者的存活期。口服核苷（酸）类似物抗病毒治疗的发展进一步降低了移植物再感染率，提高了患者的生存率。上述两种治疗方法的联合已广泛应用于乙型肝炎相关的肝移植中。
讨论乙型肝炎肝移植的术后管理，并更新预防移植物再感染的相关内容。
我们在 Ovid 和 PubMed 上检索了 2000 年 1 月至 2020 年 1 月发表的英文随机对照试验或队列研究，以评估乙型肝炎免疫球蛋白和抗病毒治疗对乙型肝炎相关肝移植的疗效。对符合既定标准的研究进行了回顾。
根据目前的证据，提出了一种抗病毒治疗的术后管理算法。此外，还讨论了接受乙型肝炎核心抗体阳性供体移植物的受者的管理。
乙型肝炎免疫球蛋白和抗病毒治疗的发展显著提高了移植物和患者的生存率。预防乙型肝炎移植物再感染是一个复杂的过程，需要多学科广泛参与。
