论文部分内容阅读
Background The most frequently used therapy for post-transplantation recurrence of hepatitis B virus(HBV)infectionis lamivudine,but this drug is associated with a high resistance rate due to YMDD mutant.In preliminary reports,adefovirdipivoxil(ADV)has been shown to have activity against lamivudine-resistant strains of HBV.However,clinical experiencein treatment of HBV infection after liver transplantation(LT)is still not entirely clear.This study was aimed to evaluate theprophylactic efficacy of ADV plus hepatitis B immunoglobulin(HBIG)in patients with YMDD mutant before LT.Methods From March 2004 to March 2006,16 patients with chronic hepatitis B had lamivudine-resistant YMDDmutants detected prior to liver transplantation and received treatment with ADV plus additional intramuscular HBIG afterLT as prophylaxis against graft reinfection.Tests for liver function,serum HBsAg,anti-HBs(HBIG),HBeAg,anti-HBc,anti-HBe,HBV-DNA,and creatinine were assessed pre-or post-liver transplantation.Results The median follow-up of these patients post-liver transplantation was 19.4 months.Fifteen patients survivedand one patient died of recurrence of hepatocellular carcinoma(HCC).There was significant difference(10.98% vs.2.26%,P<0.05)in YMDD mutant rate between the patients with HBV-DNA over 10~6 copies/ml and those with HBV-DNAless than 10~6 copies/ml.Fifteen patients(93.8%)had undetectable HBV-DNA at 4 weeks and 1(6.3%)at 6 months afterLT.No hepatitis B recurrence was detected by persistent testing of HBsAg,HBeAg,and HBV-DNA and no increase ofserum creatinine level associated with ADV was observed in any of the patients.Conclusion ADV combined with intramuscular HBIG can effectively prevent patients with pre-transplantation YMDDmutant from HBV recurrence after LT.Chin Med J 2007;120(16):1400-1403
Background The most frequently used therapy for post-transplantation recurrence of hepatitis B virus (HBV) infectionis lamivudine, but this drug is associated with a high resistance rate due to YMDD mutant. In preliminary reports, adefovirdipivoxil (ADV) has been shown to have activity Of lamivudine-resistant strains of HBV. However, clinical experience in treatment of HBV infection after liver transplantation (LT) is still not entirely clear. This study was aimed to evaluate the prophylactic efficacy of ADV plus hepatitis B immunoglobulin (HBIG) in patients with YMDD mutant before LT. Methods From March 2004 to March 2006, 16 patients with chronic hepatitis B had lamivudine-resistant YMDD mutants detected prior to liver transplantation and received treatment with ADV plus additional intramuscular HBIG afterLT as prophylaxis against graft reinfection. Tests for liver function, serum HBsAg , anti-HBs (HBIG), HBeAg, anti-HBc, anti-HBe, HBV-DNA, and creatinine were assessed pre-or post-liver transplantation. Resu lts The median follow-up of these patients post-liver transplantation was 19.4 months. Fifteen patients survived and one patient died of recurrence of hepatocellular carcinoma (HCC). There was significant difference (10.98% vs 2.26%, P <0.05) in YMDD mutant rate between the patients with HBV-DNA over 10 to 6 copies / ml and those with HBV-DNA less than 10 to 6 copies / ml. Fifteen patients (93.8%) had undetectable HBV- DNA at 4 weeks and 1 at 6 months afterLT.No hepatitis B recurrence was detected by persistent testing of HBsAg, HBeAg, and HBV-DNA and no increase of serum creatinine level associated with ADV was observed in any of the patients. Conlusion ADV combined with intramuscular HBIG can effectively prevent patients with pre-transplantation YMDDmutant from HBV recurrence after LT. Chin Med J 2007; 120 (16): 1400-1403