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本帖最后由 风雨不动 于 2012-4-14 06:41 编辑
J Hepatol. 2012 Jan 21.
Source: http://www.ncbi.nlm.nih.gov/pubmed/22274310
The Option of HBIG-Free Prophylaxis Against Recurrent HBV.
Fox AN, Terrault NA.
Source
Medicine and Transplant Surgery University of California San
Francisco.
Abstract
Since the early 1990's, hepatitis B immune globulin (HBIG) has been central
to the prevention of hepatitis B virus (HBV) recurrence after liver
transplantation. When used in combination with oral nucleos(t)ide
analogues, HBIG prevents reinfection with HBV in ?90% of transplant
recipients. While HBIG is highly efficacious, its use is undermined by its
high cost. Because of this limitation, there have been many studies of
alternative regimens seeking to minimize the dose or duration of HBIG
without sacrificing low HBV recurrence rates. Toward that goal, lower dose
intramuscular HBIG in combination with oral nucleos(t)ide analogues has
been shown to be highly efficacious in preventing disease recurrence and
represents a significant cost savings when compared with high dose
intravenous administration. The withdrawal of HBIG after a defined course
of combination HBIG and oral antivirals has also been shown to be
effective, particularly if combination antiviral therapy is used. The
ability to achieve undetectable HBV DNA levels pre-transplantation in the
majority of patients may contribute to the high efficacy of these HBIG
"light" regimens. Additionally, the success of antiviral rescue therapy for
those patients who fail prophylaxis and develop recurrent HBV infection
post-transplant has provided the impetus to move increasingly towards
HBIG-free approaches. New techniques to detect occult HBV in hepatic and
extrahepatic sites may allow clinicians to define a subgroup of patients in
whom withdrawal of HBIG or all prophylaxis may be applicable.
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发表于 2012-1-31 07:48