在活体捐赠者肝移植后预防B型肝炎的重新激活的新方案
Takuma Izumi1, Takeo Toshima1, Shinji Itoh1
1Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
概括
结合短期乙型肝炎免疫球蛋白 (HBIG) 和长期核酸类似物 (NAs) 的新预防方案,有效地防止乙型肝炎病毒 (HBV) 在肝移植 (LT) 后重新激活. 与以前的方法相比,这种策略显著改善了结果.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 移植免疫学 移植免疫学
- 病毒学 病毒学
背景情况:
- 肝移植 (LT) 后的乙型肝炎病毒 (HBV) 反激活是一个重大的临床挑战.
- 现有的预防策略需要优化,以提高疗效和缩短治疗时间.
研究的目的:
- 评估一种新型的预防方案,将长期核酸相似物 (NA) 与短期乙型肝炎免疫球蛋白 (HBIG) 结合起来,以防止LT后的HBV重新激活.
- 为了比较这种组合治疗与传统预防方案的疗效.
主要方法:
- 分析了135名为HBV相关肝病或来自乙型肝炎核心抗体阳性捐赠者的LT患者队列.
- 患者被分为两阶段:2017年10月前 (第一阶段) 和2017年10月后 (第二阶段),反映了预防方案的变化.
- 在两个时代之间比较了HBV重新激活的结果,重点关注HBIG使用的持续时间和NA管理.
主要成果:
- 第二个时代使用了短期HBIG和长期NAs (恩特卡维尔或特诺福维尔阿拉芬胺) 的组合,HBIG持续时间显著减少.
- 在第二个时代的所有患者中,HBIG成功地被停止治疗.
- 值得注意的是,在第一阶段发生了HBV的重新激活,但在第二阶段对于这两组患者来说都完全得到了预防.
结论:
- 使用短期HBIG与长期NA结合的新方案在预防LT后HBV重新激活方面非常有效.
- 这种方案为肝移植患者的HBV预防提供了足够且可能更易于管理的方法.
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