General Surgery and Organ Transplantation Unit, Department of General and Specialistic Surgery, Umberto I Polyclinic of Rome, Sapienza University of Rome, Rome, Italy.
Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Eur J Clin Invest. 2021 Aug;51(8):e13575. doi: 10.1111/eci.13575. Epub 2021 May 3.
Prophylaxis with hepatitis B immunoglobulin (HBIG) represents an efficient strategy for reducing the risk of hepatitis B virus (HBV) recurrence after liver transplantation (LT). Unfortunately, the long-term use of HBIG presents high costs. Therefore, the use of prophylaxis based only on nucleos(t)ide analogues (NUC) has been recently postulated. The present meta-analysis aimed to evaluate the impact of HBIG ± NUC vs HBIG alone or NUC alone in post-LT HBV recurrence prophylaxis.
A systematic literature search was performed using PubMed and Cochrane databases. The primary outcome investigated was the HBV recurrence after LT. Three analyses were done comparing the effect of (a) HBIG + NUC vs HBIG alone; (b) HBIG+NUC vs NUC alone; and (c) HBIG alone vs NUC alone. Sub-analyses were also performed investigating the effect of low and high genetic barrierto-recurrence NUC.
Fifty-one studies were included. The summary OR (95%CI) showed a decreased risk with the combination of HBIG + NUC vs HBIG alone for HBV recurrence, being 0.36 (95% CI = 0.22-0.61; P < .001). HBIG + NUC combined treatment reduced HBV reappearance respect to NUC alone (OR = 0.22; 95% CI = 0.16-0.30; P < .0001). Similarly, HBIG alone was significantly better than NUC alone in preventing HBV recurrence (OR = 0.20; 95% CI = 0.09-0.44; P < .0001).
Prophylaxis with HBIG is relevant in preventing post-LT HBV recurrence. Its combination with NUC gives the best results in terms of protection. The present results should be considered in light of the fact that also old studies based on lamivudine use were included. Studies exploring in detail high genetic barrier-to-recurrence NUC and protocols with definite use of HBIG are needed.
乙型肝炎免疫球蛋白（HBIG）预防可有效降低肝移植（LT）后乙型肝炎病毒（HBV）复发的风险。但遗憾的是，HBIG 的长期使用费用较高。因此，最近有人提出仅使用核苷（酸）类似物（NUC）进行预防。本荟萃分析旨在评估 LT 后 HBV 复发预防中 HBIG±NUC 与 HBIG 单药或 NUC 单药的效果。
使用 PubMed 和 Cochrane 数据库进行系统文献检索。主要观察终点为 LT 后 HBV 复发。通过三种分析比较了（a）HBIG+NUC 与 HBIG 单药、（b）HBIG+NUC 与 NUC 单药、（c）HBIG 单药与 NUC 单药的效果。还进行了亚组分析，以研究低和高遗传屏障预防复发 NUC 的效果。
共纳入 51 项研究。汇总 OR（95%CI）显示，HBIG+NUC 联合治疗降低 HBV 复发风险优于 HBIG 单药，比值比（OR）为 0.36（95%CI=0.22-0.61；P<0.001）。HBIG+NUC 联合治疗较 NUC 单药更能降低 HBV 再出现（OR=0.22；95%CI=0.16-0.30；P<0.0001）。同样，HBIG 单药预防 HBV 复发的效果明显优于 NUC 单药（OR=0.20；95%CI=0.09-0.44；P<0.0001）。
HBIG 预防在 LT 后预防 HBV 复发方面具有重要作用。其与 NUC 联合使用可提供最佳保护效果。但应注意，本研究也纳入了基于拉米夫定使用的旧研究。需要探索高遗传屏障预防复发 NUC 并制定明确使用 HBIG 方案的详细研究。
