Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
Clin Mol Hepatol. 2021 Oct;27(4):603-615. doi: 10.3350/cmh.2021.0137. Epub 2021 Sep 8.
BACKGROUND/AIMS: Hepatitis B core antibody (anti-HBc)-positive donors are used as an extended donor pool, and current guidelines recommend the usage of nucleos(t)ide analogues (NAs) as prophylaxis for preventing de novo hepatitis B virus infection (DNH). We analyzed the long-term outcomes of a large cohort of liver transplantation (LT) patients receiving anti-HBc-positive grafts and evaluated the risk of DNH when hepatitis B immunoglobulin (HBIG) monotherapy was used as prophylaxis. We also compared the cost-effectiveness of HBIG and NAs.
We retrospectively reviewed 457 patients with anti-HBc-positive grafts and 898 patients with anti-HBc-negative grafts who underwent LT between January 2001 and December 2018. We compared recipient characteristics according to the anti-HBc status of the donor, and compared the costs of using NAs for the rest of the patient's life and using HBIG to maintain hepatitis B surface antibody titers above 200 IU/L.
The 1-, 5-, and 10-year patient survival rates were 87.7%, 73.5%, and 67.7%, respectively, in patients with anti-HBc-positive grafts, and 88.5%, 77.4%, and 70.3%, respectively, in patients with anti-HBc-negative grafts (P=0.113). Among 457 recipients with anti-HBc-positive grafts, 117 (25.6%) were non-HBV recipients. The overall incidence of DNH was 0.9%. When using HBIG under insurance coverage, the cumulative cost was lower compared with using NA continuously without insurance coverage in Korea.
Anti-HBc-positive grafts alone do not affect patient survival or graft survival. HBIG monoprophylaxis has good outcomes for preventing DNH, and the patient's long-term cost burden is low in Korea because of the national insurance system in this cohort.
背景/目的：乙型肝炎核心抗体（抗-HBc）阳性供体被用作扩展供体池，目前的指南建议使用核苷（酸）类似物（NAs）作为预防药物，以防止乙型肝炎病毒（HBV）新感染（DNH）。我们分析了一组接受抗-HBc 阳性移植物的大型肝移植（LT）患者的长期结果，并评估了在使用乙型肝炎免疫球蛋白（HBIG）单药作为预防药物时发生 DNH 的风险。我们还比较了 HBIG 和 NAs 的成本效益。
我们回顾性分析了 2001 年 1 月至 2018 年 12 月期间接受 LT 的 457 例抗-HBc 阳性移植物和 898 例抗-HBc 阴性移植物的患者。我们根据供体的抗-HBc 状态比较了受者的特征，并比较了使用 NAs 维持患者余生和使用 HBIG 将乙型肝炎表面抗体滴度维持在 200 IU/L 以上的成本。
抗-HBc 阳性移植物患者的 1 年、5 年和 10 年患者生存率分别为 87.7%、73.5%和 67.7%，抗-HBc 阴性移植物患者分别为 88.5%、77.4%和 70.3%（P=0.113）。在 457 例抗-HBc 阳性移植物受者中，117 例（25.6%）为非 HBV 受者。DNH 的总发生率为 0.9%。在韩国，在保险覆盖下使用 HBIG 的情况下，与没有保险覆盖的情况下连续使用 NA 相比，累积成本较低。
单独的抗-HBc 阳性移植物不会影响患者的生存率或移植物的生存率。HBIG 单药预防 DNH 的效果良好，在本队列中由于国家保险制度，患者的长期经济负担较低。
