核苷类似物单一疗法在乙肝肝移植患者中的预防是安全有效

StephenW

Hepatol Int. 2020 Jan 10. doi: 10.1007/s12072-019-10011-2. [Epub ahead of print]
Nucleoside analog monotherapy for prophylaxis in Hepatitis B liver transplant patients is safe and efficacious.
Muthiah MD1,2,3, Tan EY4, Chua SHM4, Huang DQY1,2,3, Bonney GK2,5, Kow AWC2,5, Lim SG1,2,3, Dan YY1,2,3, Tan PS1,2,3, Lee GH6,7,8, Lim BL1,2.
Author information

1
    Department of Gastroenterology and Hepatology, National University Health System, 5 Lower Kent Ridge Road, Main Building Level 1, Singapore, 119074, Singapore.
2
    National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore.
3
    Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
4
    University Medicine Cluster, National University Health System, Singapore, Singapore.
5
    Department of Hepatobiliary and Pancreatic Surgery, National University Health System, Singapore, Singapore.
6
    Department of Gastroenterology and Hepatology, National University Health System, 5 Lower Kent Ridge Road, Main Building Level 1, Singapore, 119074, Singapore. [email protected].
7
    National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore. [email protected].
8
    Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. [email protected].

Abstract
BACKGROUND:

Combination therapy with HBIG and NAs has reduced HBV recurrence post LT. Despite its efficacy, costs of HBIG remain prohibitive. With high-potency NAs, HBIG's use has been questioned. We aim to evaluate the efficacy and safety of HBIG-free regimens in patients transplanted for HBV-related liver disease.
METHODS:

A review of LT patients at the National University Hospital, Singapore from 2001 to 2015 was performed. Patients transplanted for HBV were divided by antiviral treatment received: high- or low-potency NAs, or a combination of HBIG with high-potency NAs. Post-transplant outcomes were reviewed till data censure. Primary outcome was recurrence of HBV viremia post-transplant, while secondary outcomes were HBsAg sero-clearance, graft survival and mortality.
RESULTS:

Among 58 patients, 51 (88%) had persistent HBV viral suppression. Patients on a high-potency agent had significantly higher viral suppression compared to those on a low-potency agent (97% vs 72%, p = 0.02). This was also seen in patients with VL detectable at transplant (100% vs 50%, p < 0.01). None of the 16 patients with VL detectable at transplant and treated with high-potency agents developed recurrence. 42 patients (72%) achieved persistent HBsAg sero-clearance. Although this was higher in the high-potency NA-only group, it was not statistically significant (p = 0.56). There were no graft failures or mortalities attributed to HBV recurrence.
CONCLUSION:

With the use of high-potency agents, HBIG may not be necessary in the treatment of patients transplanted for HBV-related liver disease, even in the presence of detectable VL at time of transplant.
KEYWORDS:

Asian; Entecavir; HBIG; Hepatitis B; High potency; Lamivudine; Liver transplant; Low potency; Nucleoside analogs; Tenofovir

PMID:
    31919678
DOI:
    10.1007/s12072-019-10011-2

StephenW

Hepatol Int。 2020年1月10日。doi：10.1007 / s12072-019-10011-2。 [Epub提前发布]
核苷类似物单一疗法在乙肝肝移植患者中的预防是安全有效的。
Muthiah MD1,2,3，Tan EY4，Chua SHM4，Huang DQY1,2,3，Bonney GK2,5，Kow AWC2,5，Lim SG1,2,3，Dan YY1,2,3，Tan PS1,2,3 ，李GH6,7,8，林BL1,2。
作者信息

1个
国家大学卫生系统胃肠病学和肝病学系，新加坡肯特里奇路下5号，主楼1层，新加坡119074。
2
新加坡国立大学卫生系统，国立大学器官移植中心。
3
新加坡国立新加坡大学新加坡大学林永林医学院医学系。
4
新加坡国立大学卫生系统，大学医学集群。
5
新加坡国立大学卫生系统肝胆胰外科系。
6
国家大学卫生系统胃肠病学和肝病学系，新加坡肯特里奇路下5号，主楼1层，新加坡119074。 [email protected]。
7
新加坡国立大学卫生系统，国立大学器官移植中心。 [email protected]。
8
新加坡国立新加坡大学新加坡大学林永林医学院医学系。 [email protected]。

抽象
背景：

HBIG和NAs的联合治疗可降低LT后HBV复发。尽管具有疗效，但HBIG的成本仍然很高。对于高效能的NA，HBIG的使用受到质疑。我们旨在评估无HBIG方案在因HBV相关性肝病移植的患者中的疗效和安全性。
方法：

对新加坡国立大学医院2001年至2015年的LT患者进行了回顾。接受HBV移植的患者按抗病毒治疗分为：高或低效NA，或HBIG与高效NA的组合。回顾移植后的结果，直到数据确定为止。主要结局是移植后HBV病毒血症复发，次要结局是HBsAg血清清除率，移植物存活率和死亡率。
结果：

在58例患者中，有51例（88％）持续受到HBV病毒抑制。与使用低效药物的患者相比，使用高效药物的患者的病毒抑制显着更高（97％vs 72％，p = 0.02）。在移植时可检测到VL的患者中也发现了这一点（100％vs 50％，p <0.01）。在移植时可检测到并用高效药物治疗的16例VL患者中，没有一例复发。 42例患者（72％）达到了持久性HBsAg血清清除。尽管在仅使用NA的高能组中较高，但无统计学意义（p = 0.56）。没有因HBV复发而导致的移植失败或死亡。
结论：

通过使用高效能药物，即使在移植时存在可检测的VL的情况下，HBIG可能也不必用于治疗因HBV相关的肝病而移植的患者。
关键字：

亚洲人恩替卡韦; HBIG;乙型肝炎；效力高；拉米夫定;肝移植；效力低；核苷类似物；替诺福韦

PMID：
31919678
DOI：
10.1007 / s12072-019-10011-2