肝移植後接受者的自限性HBV感染不會重新激活：30年肝移植計

StephenW

Self-limited HBV infection of the recipient does not reactivate after liver transplantation: Observations from a 30 years liver transplant program
Ramin Raul Ossami Saidy  1 , Muenevver Demir  2 , Pauline Nibbe  1 , Eva-Maria Dobrindt  1 , Robert Oellinger  1 , Wenzel Schoening  1 , Johann Pratschke  1 , Dennis Eurich  1
Affiliations
Affiliations

    1
    Department of Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.
    2
    Department of Gastroenterology and Hepatology CVK/CCM, Charité University Medicine Berlin, Berlin, Germany.

    PMID: 32748492 DOI: 10.1111/tid.13436

Abstract

Background: A self-limited hepatitis B infection can reactivate in patients under immunosuppression or chemotherapy (reappearance of hepatitis B surface antigen (HBsAg) or HBV DNA). Exact circumstances of HBV reactivation in patients undergoing liver transplantation (LT) for end stage liver diseases (ESLD) unrelated to HBV are unknown and recommendations on HBV prophylaxis remain unclear.

Patients and methods: Among 1273 liver transplants, 168 patients with a self-limited HBV hepatitis B infection prior to LT were identified from our prospective liver transplant database. Patients with underlying chronic HBV infection and recipients of an anti-HBc-positive liver were not included in the analysis. Demographic, laboratory, serological and virological data were analyzed retrospectively. Appearance of HBsAg or HBV-DNA were defined as reactivation.

Results: The median follow-up after LT was 12.0 years (0.6-30.7 years). The rate of HBV reactivation was 0% independent of antiviral prophylaxis (n=7; 4.2%), the etiology of ESLD, hepatitis C treatment or the anti-HBs concentration. The overall patient survival with a history of a self-limited HBV infection before LT did not significantly differ from the rest of the cohort.

Conclusion: Antiviral treatment with nucleos(t)ide analogues post liver transplantation in order to prevent HBV reactivation in patients with a resolved self-limited hepatitis B infection prior to LT seems to be omittable since the main viral reservoir is removed by the hepatectomy. These findings may clarify the current uncertainty in the recommendations regarding the risk of HBV reactivation in patients with self-limited hepatitis B prior to LT.

Keywords: HBV reactivation; antiviral prophylaxis; graft loss; liver transplantation; resolved Hepatitis B infection.

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StephenW

肝移植後接受者的自限性HBV感染不會重新激活：30年肝移植計劃的觀察結果
Ramin Raul Ossami Saidy 1，Muenevver Demir 2，Pauline Nibbe 1，Eva-Maria Dobrindt 1，Robert Oellinger 1，Wenzel Schoening 1，Johann Pratschke 1，Dennis Eurich 1
隸屬關係
隸屬關係

    1個
    Charité-柏林大學醫學院外科部，德國柏林。
    2
    柏林Charité大學醫學院胃腸病學和肝病學系CVK / CCM。

    PMID：32748492 DOI：10.1111 / tid.13436

抽象

背景：在免疫抑製或化療（乙型肝炎表面抗原（HBsAg）或HBV DNA再次出現）的患者中，自限性乙型肝炎感染可重新激活。對於與HBV不相關的終末期肝病（ESLD），接受肝移植（LT）的患者進行HBV復活的確切情況尚不清楚，關於預防HBV的建議仍不清楚。

患者和方法：在我們的前瞻性肝移植數據庫中，從1273例肝移植中，鑑定出168例在LT之前發生自限性HBV乙型肝炎感染的患者。分析中不包括潛在的慢性HBV感染患者和抗HBc陽性肝的接受者。回顧性分析人口，實驗室，血清學和病毒學數據。 HBsAg或HBV-DNA的出現被定義為再激活。

結果：LT後的中位隨訪時間為12.0年（0.6-30.7年）。 HBV的重新激活率為0％，與抗病毒藥物的預防（n = 7； 4.2％），ESLD的病因，丙型肝炎治療或抗HBs濃度無關。 LT前有自限性HBV感染史的患者總體生存率與其餘隊列無明顯差異。

結論：肝移植後用核苷類似物進行抗病毒治療以防止LT之前已解決的自限性乙型肝炎感染的患者HBV激活似乎是可以省略的，因為主要的病毒庫已通過肝切除術去除。這些發現可能澄清建議中關於自限性乙型肝炎患者在LT之前HBV重新激活的風險的當前不確定性。

關鍵詞：HBV激活；預防病毒；移植物損失肝移植解決了乙型肝炎感染。

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