乙型肝炎核心抗体阳性移植物在活体肝移植中的应用

StephenW

Indian J Gastroenterol. 2018 Feb 15. doi: 10.1007/s12664-018-0823-3. [Epub ahead of print]
Utilization of hepatitis B core antibody positive grafts in living donor liver transplantation.Udayakumar VP1, Surendran S2, Padma UD3.
Author information
1Department of Pharmacy Practice, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Kochi, 682 041, India.2Department of Gastrointestinal Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, 682 041, India.3Department of Pharmacology, Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, Kochi, 682 041, India. [email protected].

AbstractBACKGROUND: Utilization of liver grafts from hepatitis B core antibody (anti-HBc) positive donors carries the risk of reactivation of hepatitis B virus (HBV) in recipients because of post-transplant immunosuppressive therapy.
METHODS: This was a retrospective study of patients who had received liver grafts from anti-HBc positive live donors between 2006 and 2016 at our institute.
RESULTS: Out of 22 recipients [all males, mean age 45.4 years (range 18-64 years)], four patients were hepatitis B surface antigen (HBsAg) positive preoperatively and received entecavir post-transplantation. One among these patients who temporarily stopped entecavir had a recurrence of hepatitis B 39 months post-transplantation. Among the 13 non-immune [hepatitis B surface antibody (anti-HBs) < 10 mIU/mL] recipients, eight were prescribed lamivudine (100 mg daily) as monoprophylaxis. Four compliant patients remain negative for HBV so far. Out of the remaining four, two died secondary to sepsis unrelated to hepatitis B; two were non-compliant and developed reactivation of hepatitis B. Lamivudine was missed out in five non-immune patients; three of them developed hepatitis B reactivation while two remain negative. Anti-HBs titer was immune in five patients. Over a period of 4 to 8 years follow up, three remain immune without prophylaxis, while two expired due to causes unrelated to hepatitis B. Following the detection of hepatitis B infection, five patients have been started on tenofovir 300 mg once daily.
CONCLUSIONS: Anti-HBc positive liver grafts can be safely used for live donor liver transplantation. If the recipients are immune preoperatively, they can be merely followed up without HBV prophylaxis. However, it is extremely important to prophylactically treat the non-immune recipients with an antiviral agent lifelong.


KEYWORDS: Antiviral prophylaxis; Nucleos(t)ide analogues; Post-transplant HBV infection

PMID:29450703DOI:10.1007/s12664-018-0823-3

StephenW

印度J Gastroenterol。 2018年2月15日。doi：10.1007 / s12664-018-0823-3。 [电子版提前打印]
乙型肝炎核心抗体阳性移植物在活体肝移植中的应用。
Udayakumar VP1，Surendran S2，Padma UD3。
作者信息

1
    Amrita药学院药剂学实践系，Amrita Vishwa Vidyapeetham，高知，682 041，印度。
2
    Amrita医学科学研究所胃肠外科，Amrita Vishwa Vidyapeetham，高知，682 041，印度。
3
    Amrita药学院药理学系，Amrita Vishwa Vidyapeetham，高知，682 041，印度。 [email protected]。

抽象
背景：

由于移植后免疫抑制治疗，利用来自乙型肝炎核心抗体（抗-HBc）阳性供体的肝脏移植物存在再活化受体中乙型肝炎病毒（HBV）的风险。
方法：

这是一项对我们研究所2006年至2016年期间从抗HBc阳性供体获得肝移植患者的回顾性研究。
结果：

22名受试者中，男性平均年龄45.4岁（范围18-64岁）]，4例患者术前接受乙肝表面抗原（HBsAg）阳性，接受恩替卡韦治疗。其中一例暂时停用恩替卡韦的患者在移植后39个月时复发乙型肝炎。在13名非免疫接种[乙型肝炎表面抗体（抗-HBs）<10 mIU / mL]接受者中，8名接受拉米夫定（每日100 mg）作为单次预防。到目前为止，四名依从性患者仍然对HBV阴性。其余四人中，两人死于继发于与乙型肝炎无关的败血症;其中两例不符合标准并且发展为乙肝重新激活。拉米夫定在五名非免疫患者中错过了;其中三人发生乙肝重新激活，而两人保持负面。 5名患者的抗-HBs效价免疫。在4至8年的随访期中，3例在没有预防的情况下保持免疫，2例由于与乙型肝炎无关的原因而过期。在检测到乙型肝炎感染后，5例患者开始替诺福韦300毫克，每日一次。
结论：

抗-HBc阳性肝脏移植物可以安全地用于活体供体肝脏移植。如果受者在术前获得免疫，那么他们只需随访即可，无需预防乙肝病毒。然而，终生使用抗病毒药预防性治疗非免疫接受者是非常重要的。
关键词：

抗病毒预防; Nucleos（t）ide类似物;移植后HBV感染

结论：
    29450703
DOI：
    10.1007 / s12664-018-0823-3