低剂量免疫球蛋白和高剂量的拉米混合治疗防治移植后复发

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Low-dose Hepatitis B Immune Globulin (HBIG) and Higher-dose Lamivudine Combination?Prevents HBV Recurrence After Liver Transplantation

Post-transplant prevention of hepatitis B virus (HBV) infection is based on treatment with lamivudine (Epivir-HBV) and/or hepatitis B immune globulin (HBIG). However, optimum doses and duration for these drugs are not yet clear.

Turkish researchers tested high doses of lamivudine (300 mg/day) in combination with low doses of HBIG (200-400 IU/2-4 weeks).

Eighty patients who had post-transplant prophylaxis of lamivudine and HBIG were included in the study. Of those, 20 had hepatitis D virus co-infection and eight were HBV DNA-positive at the time of transplantation.

Ten HBV DNA-positive patients were treated with lamivudine (150 mg/day) before transplantation; all were HBV DNA-negative after lamivudine treatment.

All patients in the anhepatic phase were given 4000 IU of HBIG. Following this, 400 or 800 IU HBIG was administered intramuscularly daily for 5-10 days post-transplantation and 2-4 times weekly thereafter, according to serum titre of antibodies to hepatitis B surface antigen (anti-HBs).

Lamivudine was maintained or initiated at the time of transplantation and was continued indefinitely. Median follow-up was 21 months (range 3-73 months).

Results

Recurrence of hepatitis B surface antigen (HBsAg)-positivity occurred in only three out of 78 (4%) patients; two of these three were HBV DNA-positive.

Median anti-HBs titre at the final follow-up was 68 IU. Patient and graft survival was 85% at 1 year.

The authors conclude, 揑n conclusion, a combination of lamivudine 300 mg/day and low-dose HBIG prevents post-transplantation recurrence of hepatitis B, even in the presence of viral replication in the pre-transplant period.?/span>

Department of Gastroenterology, Ege University Medical School, Bornova, Izmir, Turkey.

01/21/05

Reference Z Karasu and others. Low-dose hepatitis B immune globulin and higher-dose lamivudine combination to prevent hepatitis B virus recurrence after liver transplantation. Antiviral?Therapy 9(6): 921-927. December 2004.

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