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Liver transplantation is the most effective method for hepatitis B-related liver failure, liver cirrhosis and hepatocellular carcinoma. However, the reactivation of hepatitis B virus (HBV) after liver transplantation is not conducive to the recovery of liver function and leads to poor clinical prognosis. The prevention and treatment of HBV reactivation is currently the focus of research by physicians and surgeons. The current viral suppression strategies can not completely eradicate HBV nor completely prevent the recurrence of HBV infection in the future. This article aims to explore the molecular mechanism of HBV reactivation after liver transplantation, in order to more effectively prevent the recurrence of hepatitis B after liver transplantation.
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Objective To investigate the efficacy of hepatitis B vaccination in preventing hepatitis B (HBV) recurrence after liver transplantation for hepatitis B virus-related (HBV-related) recipients.Methods 30 healthy recipients who survived for more than 2 years after liver transplantation received vaccination using hepatitis B surface antigen (HBsAg)-containing vaccine.There were a total of 5 injections at 0 month, 1 month, 2 months, 3 months and 6 months respectively, and each dose was 40 μg.Thirty healthy adults who received hepatitis B vaccination during the same period were selected into the control group.The antibody of hepatitis B surface (Anti-HBs) titer was tested at 1 month, 2 months, 3 months, 6 months, 9 months and 12 months after the first vaccination.Results 6.7％ (2/30) of the liver transplantation recipients had good response (defined as a rise of Anti-HBs titer of more than 100 IU/L at 12 months after the primary vaccination), and 16.7％ of recipients (5/30) had partial response (Anti-HBs titer in 3 patients at less than 100 IU/L, Anti-HBs titer in 2 patients at more than 100 IU/L at first, then less than 100 IU/L after 12 months).For the 9 patients who received liver transplantation for acute liver failure, 2 had good response (22.2％) and another 2 patients (22.2％) had partial response.For the liver transplant recipients who survived for more than 5 years, 2 had good response (22.2％) and another patient (11.1％) had partial response.In the healthy control group, the good response rate was 73.3％ (22/30), and the partial response rate was 10％ (3/30).Conclusions Some HBV-related liver transplant recipients could acquire Anti-HBs by vaccination.Good response rate was lower in the HBV-related group of liver transplant recipients than in the healthy control group of people.Recipients for liver transplantation carried out for acute liver failure and recipients who survived for more than 5 years had higher response rates to HBV vaccination.HBV vaccination can be a way to prevent HBV recurrence in some liver transplant recipients.
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Hepatitis B recurrence is an important factor to show whether liver transplantation is successful or not. Recrrrence rate is nearly 80% in the patients liver transplantation, and HBV reinfection is the main cause of death. After the operation, HBV may copy very quickly, because of taking in immunosuppressant therapy and graft diseases develop rapidly. Recently, the exploitation and application of therapy has become a focus. Now the drugs of preventing and treating HBV reinfection are mainly sorted into passive immunity agents(Hepatitis B immunoglobulin) and antivirus therapeutic agents(interferon and nucleotide analog antivirus drugs, etc.). Lamivudine is considered the most promising new drug of treating HBV infection. This article introduced the therapeutic characteristic of these drugs.
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Objective To study the influence factors for HBV reinfection following liver transplantation.Methods 92 cases of liver transplantation were enrolled for open non-randomized clinical study.Given conventional OLTx and immunosuppressive agents and antibiotics to prevent infection etc,patients are divided into lamivudine alone and HBIG combined with lamivudine group.Observation of postoperative liver function,HBV serum markers,HBV DNA in PBMC,YMDD and HBV S gene mutation,liver tissue IH etc.Results In 92 cases of liver transplantation with HBV-related liver disease,hepatitis B recurrence rate was 4.35%(4/92).In lamivudine group the HBV infection rate was 35%(7/20);In combined therapy group the HBV infection rate was 6.94%(5/72).With preoperatively negative HBV DNA negative the hepatitis B recurrence rate was 0;With preoperatively positive HBV DNA,the postoperative HBV infection rate was 17.39%(12/69),which had cases with S gene or YMDD mutation.In patients with negative HBV DNA before and after operation,the HBV re-infection rate was 11.11%(1/9);In 5 cases with preoperative HBV DNA positive,the HBV infection rate was 4/5 after LTx;before and after operation HBV DNA are positive,the HBV infection rate was 100%(3/3);the preoperative HBV DNA positive and postoperative HBV DNA negative,the HBV infection rate was 50%(1/2).Conclusion To prevent HBV infection after LTx,lamivudine group easily leads to HBV re-infection than HBIG combined with lamivudine group.Preoperative serum HBV DNA positive,preoperative and postoperative HBV YMDD and S gene mutation are the primary factors affecting the HBV re-infection after operation.HBV DNA positive in PBMC is the source of HBV re-infection,but also the factor of recurrence of hepatitis B.