Department of Liver Surgery, The First People's Hospital of Foshan, Foshan, Guang Dong, China.
The First People's Hospital of Foshan, Foshan, Guang Dong, China.
Transplant Proc. 2021 Jun;53(5):1700-1706. doi: 10.1016/j.transproceed.2021.04.007. Epub 2021 May 22.
Limited data are available on the use of oral antiviral therapy, particularly the long-term use of entecavir monotherapy in patients with hepatitis B virus (HBV)-related diseases after liver transplant (LT).
The clinical data on consecutive patients who underwent LT for HBV-related diseases from 2011 to 2019 were prospectively collected and retrospectively analyzed. All patients received entecavir monotherapy alone during the follow-up period; viral serology/load and liver biochemical tests were performed regularly.
Among the total of 89 patients were patients with decompensated cirrhosis (n = 27 [30%]), acute-on-chronic HBV (n = 21 [24%]), and hepatocellular carcinoma (HCC) (n = 41 [46%]). The median age of the patients was 50 years (range, 42-58 years), and the median follow-up was 37 months (range, 1-96 months). Before LT, 45 (51%) patients did not receive, whereas 44 (49%) were currently receiving, oral antiviral therapy. At the time of LT, serum level of HBV DNA of 34 (38%) patients was >20 IU/mL, with the median level being 270,000 IU/mL (range, 4270-2,020,000), and 53 patients (59%) had undetectable levels of HBV DNA (≤20 IU/mL). The cumulative rate of hepatitis B surface antigen loss was 79.8%, 100%, and 100% after 1 month, 1 year, and 5 years, respectively. Hepatitis B surface antigen positivity returned after seroclearance in 1 patient, who died of HCC recurrence with an undetectable level of HBV DNA. The overall survival rates at 1, 3, and 5 years after LT were 94.51%, 86.84%, and 85.27%, respectively. During the follow-up period, no entecavir adverse reactions or dose reductions were observed.
Long-term entecavir monotherapy was highly effective in preventing HBV reactivation and HBV-related diseases.
关于口服抗病毒治疗的应用，特别是在接受肝移植（LT）后，乙型肝炎病毒（HBV）相关疾病患者中使用恩替卡韦单药治疗的长期应用，数据有限。
前瞻性收集 2011 年至 2019 年期间因 HBV 相关疾病接受 LT 的连续患者的临床数据，并进行回顾性分析。所有患者在随访期间均单独接受恩替卡韦单药治疗；定期进行病毒血清学/载量和肝功能生化检查。
89 例患者中，失代偿性肝硬化（n=27[30%]）、慢加急性乙型肝炎（n=21[24%]）和肝细胞癌（HCC）（n=41[46%]）患者各占一定比例。患者的中位年龄为 50 岁（范围，42-58 岁），中位随访时间为 37 个月（范围，1-96 个月）。LT 前，45（51%）例患者未接受，44（49%）例患者正在接受口服抗病毒治疗。LT 时，34（38%）例患者的 HBV DNA 血清水平>20 IU/mL，中位水平为 270,000 IU/mL（范围，4270-2,020,000），53（59%）例患者的 HBV DNA 水平无法检测（≤20 IU/mL）。HBsAg 丢失的累积率分别在 1 个月、1 年和 5 年后为 79.8%、100%和 100%。1 例患者在血清学清除后 HBsAg 阳性复发，HBV DNA 水平无法检测，该患者死于 HCC 复发。LT 后 1、3 和 5 年的总生存率分别为 94.51%、86.84%和 85.27%。在随访期间，未观察到恩替卡韦的不良反应或剂量减少。
长期恩替卡韦单药治疗可有效预防 HBV 再激活和 HBV 相关疾病。
