在B型肝炎中B型肝炎病毒的重新激活B型肝炎核心抗体阳性肺移植接受者肺移植接受者
Oscar A Fernandez-Garcia1, Nathan Zelyas2, Vanessa Meier-Stephenson1
1Division of Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada.
JHLT open
|March 27, 2025
概括
乙型肝炎病毒 (HBV) 的重新激活对肺移植接受者具有终身风险,HBV感染已解决. 建议对监测进行无限期的抗病毒预防,因为复活率为8%和死亡率为5%.
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
- 传染性疾病 传染性疾病
背景情况:
- 患有乙型肝炎病毒 (HBV) 感染已消失的固体器官移植受体面临重新激活的风险.
- 以前的研究主要集中在接受脏的患者,随访时间较短.
- 乙型肝炎病毒重新激活的危险因素,包括表面抗体 (抗HBs) 的保护作用,仍然不确定.
研究的目的:
- 评估肺移植接受者之前感染HBV的HBV复激活 (HBVr) 的风险.
- 为了评估抗HBs标位在该人群中对HBVr的预测值.
主要方法:
- 成年肺和心肺移植接受者的回顾性单中心研究 (2005-2019).
- 包括的患者在移植前是HBsAg阴性和抗HBc阳性.
- 主要结局:HBVr定义为血清回归到HBsAg阳性;次要结局:移植时和移植后12个月的抗HBs标位的比较.
主要成果:
- 分析了38名抗HBc阳性,HBsAg阴性血清学接受者.
- 在8% (3/38) 的患者中发生了HBV重新激活,移植后的中位数发病时间为49-94个月.
- 由于HBVr的死亡率为5% (2/38);三名HBVr患者中有两名在移植时抗HBs标位升高.
结论:
- 乙型肝炎病毒的重新激活可能迟到,这表明肺移植接受者有终身风险.
- 观察到的复激活率 (8%) 和死亡率 (5%) 支持无限期的抗病毒预防.
- 无限期预防优先于对抗HBc阳性肺移植接受者的监测.
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