Research on the oral nucleoside analogues monotherapy in the prevention of hepatitis B recurrence of patients after liver transplantation / 器官移植

ABSTRACT

Objective To explore the efficacy and safety of the oralnucle osideanalogues monotherapy in the prevention of hepatitis B recurrence of patients after liver transplantation (LT). Methods Clinical data of 32 patients with hepatitis B-related disease undergoing LT in the First People's Hospital of Foshan in Guangdong Province from October 1999 to April 2014 were retrospectively analyzed. The patients were divided into two phase groups according to the source of donors. Phase 1 was from October 1999 to September 2007 when 6 patients receiving LT of non-heart-beating donors. The serum hepatitis B virus (HBV) markers of 6 donor livers were all negative. The serum hepatitis B surface antigen (HBsAg)and hepatitis B core antibody (anti-HBc)of the recipients before operation were all positive,including 2 cases combined with Hepatitis Be antigen (HBeAg ) positive,1 case combined with hepatitis B viruse antibody (anti-HBe )positive. The serum HBV deoxyribonucleic acid (DNA)of 5 recipients before LT were over 1000 copies/ml and 1 case were below 1000 copies/ml. All the patients in phase 1 group were given lamivudine (100mg/d) monotherapy orally for the prevention of hepatitis B recurrence after LT. Phase 2 was from November 2011 to April 2014 when 26 patients receiving LT of donation after cardiac death including 1 case of combined liver-kidney transplantation. Six of the donor livers were with serum HBsAg positive and 20 cases negative. Fifteen cases were with hepatitis B surface antibody (anti-HBs)positive and 2 cases with HBeAg positive,14 cases with anti-HBc positive and 5 with anti-HBe positive. The serum HBV DNA of 11 recipients before LT were over 500 copies/ml and 15 cases below 500 copies/ml. Twenty-five cases were given entecarvir 0.5 mg/d and 1 casetelbivudine 600mg/d monotherapy or all for the prevention of hepatitis Brecurrence.Results The median follow-up time of the recipients in group phase 1 was 104 months. The serum HBsAg and HBV DNA were both negative in all recipients and no hepatitis B recurrence was observed till now. The median follow-up time of the recipients in group phase 2 was 50 weeks. Twenty cases received donor livers of negative HBsAg,in which 1 case had transient positive HBsAg 39 weeks after LT and became negative later. The patient receiving combined liver-kidney transplantation suffered hepatitis B recurrence 28 weeks after LT but HBV DNA was observed negative. No hepatitis B recurrence was observed in the 15 cases receiving donor livers of positive anti-HBc. Six cases receiving donor livers of positive HBsAg failed to become negative HBsAg after LT. All the follow-up recipients survived. No HBV DNA replication was observed in the recipients after LT. No adverse reaction of related nucleoside analogues was observed.Conclusions It is effective and safe tousenucleoside analogues monotherapy for the prevention of hepatitis B recurrence in patients after LT.