Impact of Virologic Breakthrough and HBIG Regimen on Hepatitis B Recurrence After Liver Transplantation

被引:74
作者
Degertekin, B. [1 ]
Han, Steven-Huy B. [2 ]
Keeffe, E. B. [3 ]
Schiff, E. R. [4 ]
Luketic, V. A. [5 ]
Brown, R. S., Jr. [6 ]
Emre, S. [7 ]
Soldevila-Pico, C. [8 ]
Reddy, K. R. [9 ]
Ishitani, M. B. [10 ]
Tran, T. T. [11 ]
Pruett, T. L. [12 ]
Lok, A. S. F. [1 ]
机构
[1] Univ Michigan Hlth Syst, Div Gastroenterol, Ann Arbor, MI USA
[2] Univ Calif Los Angeles, Los Angeles, CA USA
[3] Stanford Univ, Med Ctr, Div Gastroenterol & Hepatol, Stanford, CA 94305 USA
[4] Univ Miami, Miami, FL USA
[5] Virginia Commonwealth Univ, Richmond, VA USA
[6] Columbia Presbyterian Med Ctr, New York, NY 10032 USA
[7] Yale Univ, Sch Med, New Haven, CT USA
[8] Univ Florida, Gainesville, FL USA
[9] Univ Penn, Philadelphia, PA 19104 USA
[10] Mayo Clin, Rochester, MN USA
[11] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA
[12] Univ Virginia, Charlottesville, VA USA
基金
美国国家卫生研究院;
关键词
Adefovir; antiviral resistance; HBV DNA; hepatitis B e antigen; lamivudine; LONG-TERM PROPHYLAXIS; IMMUNE GLOBULIN; ADEFOVIR DIPIVOXIL; LAMIVUDINE; VIRUS; IMMUNOGLOBULIN; COMBINATION; PREVENTION; MANAGEMENT; RESISTANCE;
D O I
10.1111/j.1600-6143.2010.03046.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
The availability of hepatitis B immune globulin (HBIG) and several oral antiviral therapies has reduced but not eliminated hepatitis B virus (HBV) recurrence. We aimed to determine the rate of HBV recurrence after orthotopic liver transplantation (OLT) in relation to virologic breakthrough pre-OLT and HBIG regimens post-OLT. Data from the NIH HBV-OLT database were analyzed. A total of 183 patients transplanted between 2001 and 2007 followed for a median of 42 months (range 1-81) post-OLT were studied. At transplant, 29% were hepatitis B e antigen (HBeAg) (+), 38.5% had HBV DNA > 5 log(10) copies/mL, 74% were receiving antiviral therapy. Twenty-five patients experienced virologic breakthrough before OLT. Post-OLT, 26%, 22%, 40% and 12% of patients received intravenous (IV) high-dose, IV low-dose, intramuscular low-dose and a finite duration of HBIG, respectively as maintenance prophylaxis. All but two patients also received antiviral therapy. Cumulative rates of HBV recurrence at 1 and 5 years were 3% and 9%, respectively. Multivariate analysis showed that listing HBeAg status and HBV DNA level at OLT were the only factors associated with HBV recurrence. In conclusion, low rates of HBV recurrence can be accomplished with all the HBIG regimens used when combined with antiviral therapy including patients with breakthrough pre-OLT as long as rescue therapy is administered pre- and post-OLT.
引用
收藏
页码:1823 / 1833
页数:11
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