Entecavir combined with immunoglobulin prevents hepatitis B recurrence after liver transplantation

doi:10.3969/j.issn.2095-4344.2013.31.002

Abstract

Abstract:

BACKGROUND: Prolonged therapy with lamivudine has been associated with tyrosine-methionine-aspartate- aspartate mutation, which results in hepatitis B recurrence. Recently, antiviral agents, such as entecavir, have high efficacy and low resistance rate in hepatitis B-related liver disease. However, the researches on the effect of entecavir in preventing hepatitis B recurrence after liver transplantation are rare.
OBJECTIVE: To investigate the effect of entecavir combined with low-dose hepatitis B immunoglobulin in preventing hepatitis B recurrence after liver transplantation.
METHODS: The follow-up data of 253 patients who had liver transplantation for hepatitis B virus related liver disease were retrospectively analyzed. All patients received nucleoside analogues therapy formally before liver transplantation. The effects of entecavir+hepatitis B immunoglobulin and lamivudine+hepatitis B immunoglobulin were compared in all the patients and the patents with hepatitis B recurrence risk factors (positive preoperative HBeAg, DNA-positive hepatitis B virus, hepatoma and tyrosine-methionine-aspartate-aspartate mutation).
RESULTS AND CONCLUSION: A total of 253 patients received hepatitis B virus-related liver transplantation, and 29 patients died. There were 202 patients in lamivudine group in which 26 patients were dead and 16 patients had hepatitis B virus recurrence, and the recurrence rate was 7.92% (16/202). However, entecavir group had 51 patients without hepatitis B virus recurrence in which three patients were dead. There were significant differences in the mortality rate and recurrence rate between two groups. Compared with the lamivudine+hepatitis B immunoglobulin, entecavir+hepatitis B immunoglobulin could effectively reduce the recurrence rate of the patients with hepatitis B virus-related risk factors. Hepatitis B immunoglobulin was terminated and nucleoside analogues were modulated when recurrence appeared. All patients hepatitis B virus DNA were controlled less than 500 IU/mL and liver function returned to normal level. Log-rank test showed that there was no significant difference in the long-term survival rate after timely treatment of hepatitis B virus recurrence. With the prevention of nucleoside analogues combined with hepatitis B immunoglobulin therapy, timely treatment of hepatitis B recurrence has little influence on the prognosis. Entecavir combined with hepatitis B immunoglobulin can effectively prevent the hepatitis B recurrence. For the patients with hepatitis B virus-related risk factors, entecavir combined with hepatitis B immunoglobulin can better reduce the recurrence rate of hepatitis B than lamivudine+hepatitis B immunoglobulin after liver transplantation.

Key words: organ transplantation, liver transplantation, hepatitis B, hepatitis B virus related, tyrosine-methionine- aspartate-aspartate mutation, entecavir, lamivudine, uucleoside, human immunoglobulin, recurrence

CLC Number:

R318

Gao Yin-jie, Liu Zhen-wen, Zhang Min, Su Hai-bin, Zhou Shuang-nan, Zhou Xia, Zhang Da-li, He Xi, Tang Ru-jia. Entecavir combined with immunoglobulin prevents hepatitis B recurrence after liver transplantation[J]. Chinese Journal of Tissue Engineering Research, doi: 10.3969/j.issn.2095-4344.2013.31.002.

Figures/Tables 3

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