Clinical efficacy of application of hepatitis B surface antigen-positive donor liver in liver transplantation / 器官移植

Objective To evaluate the clinical efficacy of application of hepatitis B surface antigen (HBsAg)-positive donor liver in adult liver transplantation. Methods Clinical efficacy of 28 recipients with liver diseases induced by virus B hepatitis (hepatitis B) undergoing liver transplantation using HBsAg-positive donor liver from July 2012 to October 2015 was retrospectively analyzed. Clinical prognosis and postoperative complications of the recipients were summarized. The changing features of serum levels of HBsAg and hepatitis B virus (HBV) DNA was investigated. Results After liver transplantation, 28 recipients were orally administered with entecavir to prevent the recurrence of hepatitis B. During perioperative period, 2 recipients died from sepsis and acute heart failure. During postoperative follow-up, 2 cases died from the recurrence of hepatocellular carcinoma (liver cancer). The remaining 24 patients were followed up for 12-26 months. Throughout the follow-up, 24 recipients were positive for serum HBsAg. After treatment, the titre of HBV DNA was significantly declined to <1×102 copies/mL at postoperative 12 months. No graft dysfunction induced by hepatitis B recurrence occurred in 24 recipients alive. Conclusions As a marginal donor liver, HBsAg-positive liver graft is safe for liver transplantation in the recipients with hepatitis B-related liver diseases. Postoperatively, anti-HBV treatment should be strengthened and intimate follow-up should be delivered.

Analysis on correlation between intramuscular HBIG in late pregnancy with neonatal and postnatal milk HBV DNA content / 国际检验医学杂志

Objective To analyze and compare the HBV DNA contents in serum and breast milk after injection of hepatitis B im‐munoglobulin (HBIG) in different periods of pregnant and lying‐in women to provide the experimental basis for blocking the mater‐nal‐neonatal transmission(PMTCT) and breast feeding scheme .Methods 140 pregnant women carrying hepatitis B virus with HB‐sAg(+ ) by antenatal examination in the obstetric outpatient department of our hospital from June 2012 to June 2014 were selected and divided into the research group and the control group according to the voluntary and secretive principle .Among them ,75 cases in the research group were intramuscularly injected by high titer HBIG 200 U at 28 ,32 ,36 weeks of pregnancy ,while 65 cases in the control group were injected by HBIG at the end of pregnancy due to different causes .Serum HBV‐DNA content before injection and before delivery was detected in the two groups ,and which in neonatal serum and breast milk within 3-5 d also detected .The differences and correlation between the two groups were analyzed .Results The HBV‐DNA content 1 × 106 copies/mL before HBIG injection in the research group were 28 cases ,17 cases ,30 cases respectively ,which before delivery were 35 cases ,20 cases ,20 cases respectively ;which in antenatal twice detection in the control group were 19 cases , 21 cases ,25 cases and 20 cases ,17 cases ,28 cases respectively ;neonatal serum HBV‐DNA positive in the research group and control group had 1 case(5 .3% ) and 5 cases (7 .7% ) respectively ;the breast milk HBV‐DNA positive in the two groups had 3 cases(4% )/and 8 cases(12 .3% ) respectively .Conclusion HBIG injection at late pregnancy in the pregnant women carrying HBV could influ‐ence the HBV replication ,thus reduces the probability of neonatal intrauterine infection ,at the same time reduces the HBV‐DNA positive rate of postpartum breast milk .

Immunity mechanism of vertical transmission blocking for HBV immunoglobulin injection to pregnant women / 中国免疫学杂志

Objective:To discuss the passive immunity effect and mechanism of HBIG injections to matrix to block the mother-to-child vertical transmission of HBV. Methods:94 cases of patients with chronic viral hepatitis were selected and divided into 3 groups randomly. 31 cases of control group were given no HBIG intervention,while 31 cases of baby intervention ( BBI) group were given HBIG injection in 6h of birth,and 32 cases of infant & mom intervention ( IMI) group were given HBIG injection respectively in 28,32,36 weeks of gestation and 6h of birth. Further more,all newborns were vaccinated against hepatitis B in 0,1 and 6 months,after the last vaccination,peripheral blood of the children were extracted and detected for HBV markers,HBV-DNA and immune function. Results:There were significant difference (P<0. 05) in neonatal HBeAg,HBsAg and HBV-DNA positive rate for the three groups,with Control group got the highest while IMI group got the lowest;and there are also significant differences (P<0. 05) HBeAb positive rate,with Control group got the lowest while IMI group got the highest. We also found that the complement (C3,C4) levels and T cell subtypes (CD3+,CD4+,CD8+) count of the three groups of newborns had significant differences too(P<0. 05),with Control group got the lowest while IMI group got the highest;in terms of immunoglobulin,both the IMI and BBI group were higher in IgG and IgM level (P<0. 05), while there was no obvious difference in IgA between groups (P<0. 05). Conclusion:Maternal HBIG injections can effectively activate the maternal humoral immunity and cellular immunity,resulting in the decrease of HBV. It can also improve newborn′s antigen-antibody response and relieve T lymphocytes loss induced by antiviral consumption through placenta,which may play great role in the passive im-munity mechanism of blocking mother-to-fetus transmission.

The immune effect of combined immunization for newborns of pregnant women with HBeAg-negative chronic hepatitis B / 中国医师进修杂志

Objective To evaluate the immune effect of combined immunization for newborns of pregnant women with HBeAg-negative chronic hepatitis B.Methods Three hundred and seventy-five cases of children given birth by 326 cases of HBeAg-negative HBV-infected pregnant women were enrolled in this study.The usage of hepatitis B immunoglobulin (HBIG) during pregnancy,mode of delivery,the child's immunization measures after the birth and feeding patterns were recorded,and compared the HBV markers.Results All of 375 cases of children were given HBIG after delivery for 12 h,352 (93.9％) cases of children were given the first time of hepatitis B vaccines(HepB) after delivery for 24 h,and 23 (6.1％) cases of children were delayed because of all kinds of neonatal disease,but they were given vaccination after delivery for 7-42 d.Two hundred and thirty-six cases of cord blood were detected for HBV markers,39 (16.5％) cases were HBsAg positive,197 (83.5％) cases were HBsAg negative.The positive rate of anti-HBs and the meta-concentration of anti-HBs in the child with HBsAg positive and HBsAg negative of cord blood had no significant difference (P ＞ 0.05).The positive rate of anti-HBs of children whose mothers used HBIG or not during pregnancy were 63.5％ (47/74),59.8％(180/301).The positive rate of anti-HBs in cesarean section group and the nature delivery group were 65.2％ (103/158),57.1％ (124/217).The positive rate of anti-HBs in breast feeding,mixed feeding and artificial feeding group were 62.0％ (119/192),58.9％ (63/107),59.2％(45/76).There was no significant difference(P ＞ 0.05).Conclusions After normal HBIG combined HepB,different mode of delivery,feeding,third trimester whether given HBIG have no effect on the newborns of pregnant women with HBeAg-negative chronic hepatitis B.

Efficacy of Hepatitis B Immune Globulin for Prevention of De Novo Hepatitis B in Living-related Liver Transplantation / 대한소아소화기영양학회지

PURPOSE: Hepatic allografts from donors with hepatitis B core antibody have been demonstrated to transmit hepatitis B virus (HBV) infection to recipients after liver transplantation (LT). The efficacy of hepatitis B immune globulin (HBIg) to prevent de novo hepatitis B was investigated by comparing active immunization in the early phase to HBIg monotherapy in the late phase of pediatric liver transplants at Samsung Medical Center. METHODS: Among pediatric liver transplants, from May, 1996 to June, 2002, 15 recipients who were hepatitis B surface antigen (HBsAg) (-) received an allograft from a donor with hepatitis B core antibody (HBcAb) (+). Except two who died from unrelated causes, eleven of 13 recipients were HBsAb (+), and 2 were naive (HBsAb(-), HBcAb(-)). All patients were vaccinated for HBV before LT. In the early phase (January, 1997~November, 1997, 3 patients), HBsAb (+) recipients received booster vaccination after LT. In the late phase (December, 1997~, 10 patients), all recipients were given booster vaccination and received HBIg therapy in order to maintain HBsAb titer greater than 200 IU/L. Lamivudine was given in one case because of severe side effect of HBIg. We retrospectively analyzed the effect of the preventive therapy for de novo hepatitis B through medical records. RESULTS: De novo hepatitis B developed in three of 13 recipients (23.1%). All of 3 patients who received active immunization in the early phase became HBsAg (+) at 7~19 months after transplantation. One of them was naive before LT and the other two were HBsAb (+). All of 10 recipients who were given HBIg in the late phase remained HBsAg (-) at 7~55 months' follow-up. CONCLUSION: Passive immunization with HBIg was effective for prevention of de novo hepatitis B in HBsAg (-) recipients of hepatic allografts from HBcAb (+) donors.

Prevention of HBV Reinfection in Perioperative Period of Liver Transplantation / 中国普外基础与临床杂志

Objective To investigate the prevention of HBV reinfection in the perioperative period of liver transplantation on HBV-related diseases.Methods Published papers were collected and reviewed.Results HBV-related diseases were the main indications of liver transplantation.The prevention for HBV reinfection affects the survivals remarkably.Nowadays,a lot of medication have been used in the prevention of HBV reinfection,and the therapeutic regimens were different from each other.Conclusion Liver transplantation is an effective treatment for HBV-related disease.Appropriate prevention of HBV reinfection in the perioperative period of liver transplantation is important for the survivals of patients.

Prophylaxis against Hepatitis B Recurrence Following Liver Transplantation in HBsAg( ) Patients: Hepatitis B Immune Globulin vs Lamivudine

PURPOSE: Thanks to hepatitis B immune globulin (HBIG) and antiviral agents such as Lamivudine , HBV cirrhosis is no longer a contraindication of liver transplantation. Actually it is frequent indication for liver transplantation in Korea. However, to date, the most effective HBV prophylaxis regimen has not been determined. The purpose of this study was to evaluate whether the regimen consisting of lamivudine and one-week HBIG for the hepatitis B virus (HBV) prophylaxis following liver transplantation is as effective as a long-term therapy of high dose HBIG. METHODS: From May 1996 to December 1999, 58 patients among a total of 80 cases of liver transplantation were hepatitis B surface antigen positive preoperatively. They were grouped into two protocol regimens, the HBIG group and the Lamivudine combination group, at random. 43 patients (19 patients in the HBIG group, twenty four patients in the Lamivudine combination group) who survived more than 90 days were included in this study. The recurrence was defined as the conversion of HBs-Ag from negative to positive. RESULTS: There was no statistical significance between the two groups in regards to age, sex or the preoperative positive rate of HBeAg. The mean follow-up duration was 27 months (range from 6-55). Of the 43 patients, 5 patients were converted to HBs-Ag positive in serum; two were in theHBIG group and three in the Lamivudine combination group. There was no statistical significance in HBV recurrence rate between the two groups (p=0.97). CONCLUSION: The combined therapy of lamivudine and one week HBIG has an effect equivalent to a long term therapy of high dose HBIG in HBV prophylaxis following liver transplantation.

Analysis of the effects of gene hepatitis B vaccine associated with hepatitis B immune globulin on interrupting the mother-infant transmission of hepatitis B virus / 重庆医科大学学报

Objective:To understand the efficacy of gene hepatitis B vaccine associated with hepatitis B immune globulin on interrupting the mather-infant transmission of HBV and to explore the most effective immunotherapy plan.Methods:A total of 99 cases of HBsAg-positive pregnant women were chosen as investigation objects,which were then divided into test and control groups by various testing period.According to the different vaccination ways of hepatitis B vaccine,test groups were divided into Group A(muscular injection way)and Group B(intradermal injection way).Pregnant women in the test groups were intramuscularly injected with HBIG of 200IU at week 28,32 and 36 of gestation;the neonates were intramuscularly injected with HBIG of 200IU at postnatal 4 h,and on the 15th and 30th day and vaccinated gene Hepatitis B vaccine of 5 ?g at birth date,a month and six months after birth respectively.Control group were routinely inoculated by hepatitis B vaccine.HBsAg and anti-HBs in the serum were monitored by following-up the children for five years.Results:The blocking rate of mother-infant transmission of HBV in test group was 98.36%,however,the blocking rate of control group was 83.33%(P0.05).The blocking rate in HBeAg and HBsAg-positive group was 77.78%,but,in HBsAg-positive group,the blocking rate was 97.26%(P