Grellier L, Mutimer D, Ahmed M, Brown D, Burroughs A K, Rolles K, McMaster P, Beranek P, Kennedy F, Kibbler H, McPhillips P, Elias E, Dusheiko G
University Department of Medicine, Royal Free Hospital School of Medicine, London, UK.
Lancet. 1996 Nov 2;348(9036):1212-5. doi: 10.1016/s0140-6736(96)04444-3.
Orthotopic liver transplantation in patients positive for hepatitis B virus (HBV) DNA is associated with a high reinfection rate, even with hepatitis B immunoglobulin (HBIG) prophylaxis. Nucleoside analogues that inhibit hepatitis B replication in patients with chronic hepatitis B could prevent reinfection after transplantation. The aim of this study was to analyse the efficacy and safety of prophylaxis both before and after transplantation with the nucleoside analogue lamivudine, without HBIG, in patients undergoing liver transplantation.
17 HBsAg-positive patients with decompensated cirrhosis and previous evidence of viral replication were enrolled. 12 were HBV-DNA-positive by a signal amplification assay. Patients were treated with oral lamivudine (100 mg daily) for at least 4 weeks before transplantation and followed up for 18-90 weeks after transplantation.
HBV DNA became undetectable in serum before transplantation in all HBV-DNA-positive patients. Four died before transplantation from complications of cirrhosis; one patient was withdrawn from the study because of a cerebrovascular accident. The remaining 12 patients underwent transplantation. Two patients died after transplantation (one at 3 days and one [suicide] at 20 weeks). HBV DNA reappeared in one patient with histological evidence of recurrent hepatitis (72 weeks). By week 24 the nine remaining patients had lost HBsAg and remained negative for HBV DNA.
Lamivudine treatment may prove useful in preventing recurrence of hepatitis B after liver transplantation. The effect on survival of patients after transplantation remains to be assessed.
即使采用乙肝免疫球蛋白（HBIG）预防措施，乙肝病毒（HBV）DNA阳性患者进行原位肝移植后的再感染率仍很高。抑制慢性乙肝患者乙肝病毒复制的核苷类似物可预防移植后的再感染。本研究旨在分析在肝移植患者中，不使用HBIG，移植前后使用核苷类似物拉米夫定预防的疗效和安全性。
纳入17例HBsAg阳性且有失代偿性肝硬化及既往病毒复制证据的患者。12例通过信号放大检测法检测为HBV-DNA阳性。患者在移植前口服拉米夫定（每日100mg）至少4周，并在移植后随访18 - 90周。
所有HBV-DNA阳性患者在移植前血清中HBV DNA均检测不到。4例患者在移植前死于肝硬化并发症；1例患者因脑血管意外退出研究。其余12例患者接受了移植。2例患者在移植后死亡（1例在3天，1例在20周时自杀）。1例患者出现HBV DNA复发，伴有复发性肝炎的组织学证据（72周）。到第24周时，其余9例患者HBsAg消失且HBV DNA仍为阴性。
拉米夫定治疗可能对预防肝移植后乙肝复发有用。其对移植后患者生存的影响仍有待评估。
