HBV DNA persistence 10 years after liver

liver411

[B]transplantation despite successful anti-HBS passive immunoprophylaxis.[/B] Hepatology. 2003 Jul;38(1):86-95. Roche B, Feray C, Gigou M, Roque-Afonso AM, Arulnaden JL, Delvart V, Dussaix E, Guettier C, Bismuth H, Samuel D. Centre Hepato-Biliaire, Hopital Paul Brousse, Villejuif, France. Long-term immunoprophylaxis with hepatitis B immune globulin (HBIG) is widely accepted for the prevention of recurrent hepatitis B virus (HBV) infection after liver transplantation in HBV-infected patients without viral replication. We report long-term results of HBIG administration in 284 hepatitis B surface antigen (HBsAg)-positive transplant patients. In protocol 1, 259 patients were given HBIG with the goal of maintaining the anti-HBs antibody (Ab) titer over 100 IU/L. After December 1993, 25 HBV DNA-positive patients received HBIG, with a target anti-HBs Ab titer over 500 IU/L, combined with posttransplantation antiviral therapy (protocol 2). At 10 years, 44 patients without recurrence were tested for the presence of HBV DNA in serum using real-time polymerase chain reaction (PCR); 28 were also tested in liver and peripheral blood mononuclear cells (PBMC). The overall 5- and 10-year posttransplantation actuarial rates of HBV recurrence were 24.2% and 25.4%, respectively. The 5-year recurrence rate in protocol 2 patients was 11.8%. On multivariate analysis, predictors of lower HBV recurrence risk were absence of serum HBV DNA before transplantation (P <.0001), acute liver disease (P =.0037), HDV superinfection (P =.012), and protocol 2 therapy (P <.0001). Low-level HBV DNA was detected by PCR in 45.4% of patients without HBV recurrence at 10 years. Overall actuarial 10-year survival was 74.4%. In conclusion, we confirm the efficacy of long-term HBIG immunoprophylaxis. Combination prophylaxis with HBIG and antiviral therapy is effective in patients with viral replication. Although there were only a few cases of HBV recurrence after 5 years, HBV DNA remained present in 45% of patients at 10 years. Publication Types: Clinical Trial PMID: 12829990 [PubMed - indexed for MEDLINE]

雪绒花

肝移植后在１０年里尽管表面抗体被动免疫成功ＨＢＶＤＮＡ持续存在 肝病学杂志 2003 七月； Roche B, Feray C, Gigou M, Roque-Afonso AM, Arulnaden JL, Delvart V, Dussaix E, Guettier C, Bismuth H, Samuel D. Biliaire肝病学中心, Hopital 保罗 布鲁斯, Villejuif, 法国. 长期接种乙肝免疫球蛋白被广泛承认用于预防没有滤过性毒菌引起复制的肝移植患者的再次被乙肝病毒感染。我们报告了乙肝免疫球蛋白用于治疗284例表面抗原阳性的肝移植患者的长期疗效。在协议里1259名患者被给予乙肝免疫球蛋白治疗以维持其体内的表面抗体滴度超过100IU/L。1993年十二月之后，25名HBVDNA呈阳性的患者被给予乙肝免疫球蛋白合并转录后的抗滤过性病原体的治疗，目的是使他们的表面抗体滴度超过500IU/L。（协议2）在10年的时间里，44名没有复发的患者被用聚合酶连锁反应法（ＰＣＲ）测试血清HBVDNA含量；２８名患者还被测试肝脏及周围血液内的单核细胞（ＰＢＭＣ）。全部５年和１０年的乙肝病毒再次感染转录的统计比率分别为24.2% 和 25.4%,在协议２里，５年的患者再感染率为11.8%。在多变量分析上，降低乙肝病毒再感染风险的预言者血清内没有ＨＢＶＤＮＡ(P<.0001),肝病加剧的(P =.0037),丁肝病毒双重感染的(P =.012)，协议２的治疗(P <.0001)。在10年的时间里，没有乙肝病毒重复感染的患者用ＰＣＲ法检测发现保持低水平的ＨＢＶＤＮＡ的占45.4%，１０年存活率的统计结果是74.4%。结论是我们确认了长期接种乙肝免疫球蛋白的疗效。结合用乙肝免疫球蛋白预防和抗滤过性病原体的治疗在滤过性毒菌引起复制的患者中是有效的，虽然５年之后有些病例复发，但在１０年的时间里ＨＢＶＤＮＡ持续出现的只占45%。 出版类型　　 临床试验 PMID: 12829990 [PubMed - indexed for MEDLINE]

雪绒花

发表在8月号《美国移植学杂志》上的一项研究表明，拉米夫定与HBIg联合治疗能够有效预防肝移植前HBsAg阳性/HBV DNA阴性患者的HBV感染复发。法国里昂Edouard Herriot医院的Dumortiera博士指出，乙肝免疫球蛋白（HBIg）能够有效预防肝移植（LT）后的乙肝病毒（HBV）感染复发。研究人员选取1990至2001年间进行LT的60例HBsAg阳性/HBV DNA阴性患者（全部60例患者均经静脉输入HBIg，使其血清抗HB水平维持在约500 IU/L以上），探讨了拉米夫定与HBIg联合治疗能否有效预防LT后的HBV感染复发。结果发现，历史对照组在平均随访98个月后的复发率为23%。5例患者因HBV相关性肝病死亡。
　　研究人员指出，平均随访30个月后，17例联合治疗组患者均未出现HBV感染复发。PCR检查发现，每例患者的至少3份血清标本都不具有HBV DNA。而且，联合治疗组的HBV感染复发率显著低于历史对照组。
　　Dumortiera博士认为，拉米夫定与HBIg联合治疗能够避免LT前呈HBsAg阳性/HBV DNA阴性的患者复发HBV感染。