Novel protocol for prevention from hepatitis B reactivation following living-donor liver transplantation

IF 3.9 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Hepatology Research Pub Date : 2024-09-14 DOI:10.1111/hepr.14110

Takuma Izumi, Takeo Toshima, Shinji Itoh, Shohei Yoshiya, Yuki Bekki, Norifumi Iseda, Yuriko Tsutsui, Katsuya Toshida, Yuki Nakayama, Takuma Ishikawa, Tomoharu Yoshizumi

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引用次数: 0

Abstract

Aim

Reactivation of hepatitis B virus (HBV) after liver transplantation (LT) remains a problem; thus, development of more effective HBV reactivation prophylaxis is desirable. We evaluated the efficacy of a combination of a long-term nucleotide analog (NA), such as entecavir (ETV) or tenofovir alafenamide (TAF), and short-term hepatitis B immunoglobulin (HBIG) in preventing HBV reactivation and compared it with conventional HBV prophylaxis.

Methods

Between February 1999 and August 2023, 135 patients underwent living-donor liver transplantation for liver cirrhosis or acute liver failure caused by HBV infection or received an LT from a hepatitis B core antibody-positive donor. Recipients who had undergone LT were classified as being in the first or second era (namely until September 2017 and from October 2017), respectively, and outcomes of prophylaxis against HBV reactivation were compared between the two eras.

Results

In the second era, recipients with HBV-related disease or who had received hepatitis B core antibody-positive liver received combination therapy with short-term HBIG and an NA such as TAF and ETV long-term. The duration of HBIG treatment was markedly shorter than in the first era in both categories of patients and HBIG could be discontinued in all cases. Surprisingly, we observed HBV reactivation in the first era, but not in the second era, in both groups.

Conclusions

We have established a protocol for prophylaxis against HBV reactivation using a combination of short-term HBIG and long-term NA. This protocol was found to be sufficient to prevent HBV reactivation after LT.

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活体肝移植后预防乙型肝炎再激活的新方案

目的肝移植（LT）后乙型肝炎病毒（HBV）再活化仍是一个问题；因此，开发更有效的 HBV 再活化预防方法是可取的。我们评估了恩替卡韦（ETV）或替诺福韦阿拉非那胺（TAF）等长期核苷酸类似物（NA）与短期乙型肝炎免疫球蛋白（HBIG）联合使用预防 HBV 再激活的效果，并与传统的 HBV 预防方法进行了比较。方法1999年2月至2023年8月期间，135名患者因HBV感染引起的肝硬化或急性肝功能衰竭接受了活体肝移植，或接受了乙肝核心抗体阳性供体的LT。接受过LT的受者分别被划分为第一或第二时代（即2017年9月之前和2017年10月起），并比较了两个时代预防HBV再激活的结果。结果在第二时代，患有HBV相关疾病或接受过乙肝核心抗体阳性肝脏的受者接受短期HBIG和NA（如TAF和ETV）长期联合治疗。在这两类患者中，HBIG 治疗的持续时间明显短于第一个疗程，而且所有病例都可以停用 HBIG。令人惊讶的是，我们在第一阶段观察到了 HBV 再激活，但在第二阶段，两组患者均未观察到 HBV 再激活。我们发现，该方案足以预防 LT 后的 HBV 再激活。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hepatology Research 医学-胃肠肝病学

CiteScore

8.30

自引率

14.30%

发文量

124

审稿时长

1 months

期刊介绍： Hepatology Research (formerly International Hepatology Communications) is the official journal of the Japan Society of Hepatology, and publishes original articles, reviews and short comunications dealing with hepatology. Reviews or mini-reviews are especially welcomed from those areas within hepatology undergoing rapid changes. Short communications should contain concise definitive information.