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发表于 2002-9-9 16:57
Hepatology 2002 Sep;36(3):702-709
Preemptive use of lamivudine reduces hepatitis B exacerbation after
allogeneic hematopoietic cell transplantation.
Lau GK, He ML, Fong DY, Bartholomeusz A, Au WY, Lie AK, Locarnini S, Liang
R.
Division of Gastroenterology and Hepatology, Division of Hematology,
Department of Medicine, Institute of Molecular Biology, and Clinical Trials
Centre, University of Hong Kong, Hong Kong Special Administrative Region,
China; and Victorian Infectious Diseases Reference Laboratory, Fairfield,
Victoria, Australia.
Exacerbation of hepatitis B virus (HBV) is a serious cause of morbidity and
mortality in hepatitis B surface antigen (HBsAg)-positive patients
undergoing transplantation. Our aim was to evaluate the effectiveness of
lamivudine to prevent hepatitis due to exacerbation of HBV in HBsAg-positive patients treated with allogeneic hematopoietic cell transplantation. We studied 20 consecutive HBsAg-positive recipients of allogeneic hematopoietic cell transplantation who received lamivudine 100 mg daily starting one week before transplantation until week 52 after transplantation (group 1). Serial serum alanine aminotransferase and HBV DNA levels were measured before and after transplantation at 4- to 8-week intervals for the first year and then 4- to 12-week intervals. Their virologic and clinical outcomes were compared with 20 case-matched recipients who did not receive any antiviral therapy to HBV (anti-HBV) before and after hematopoietic cell transplantation (group 2). After transplantation, 9 patients (45%) in group 2 and one patient (5%)
in group 1 had hepatitis due to exacerbation of HBV (P <.008), with 3
hepatic failures in group 2 and none in group 1. The one-year actuarial
probability of survival without hepatitis due to exacerbation of HBV was
higher in group 1 than group 2 (94.1% vs. 54.3%, P =.002). By multivariate
Cox analysis, preemptive use of lamivudine effectively reduced hepatitis due to exacerbation of HBV (adjusted hazards ratio, 0.09; P =.021). In
conclusion, preemptive lamivudine reduced HBV exacerbation. The use of
lamivudine with other immunosuppressive regimens to prevent exacerbation of HBV should be further explored. HEPATOLOGY 2002;36:702-709.)
PMID: 12198664 [PubMed - as supplied by publisher]
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