KARACİĞER NAKLİ SONRASI HEPATİT B NÜKSÜNÜN ÖNLENMESİNDE KISA SÜRELİ DÜŞÜK DOZ HEPATİT B İMMÜNOGLOBULİNİ İLE NÜKLEOTİD ANALOĞU KOMBİNASYONUNUN ETKİNLİĞİ Efficacy of Combining Nucleotide Analog and Shorter Low Dose Hepatitis B Immunoglobulin Administration on Post-Transplant Hepatitis B Recurrence
Abstract
ÖZET
Amaç: Hepatit B’ye bağlı siroz nedeniyle karaciğer nakli yapılan hastalarda hepatit B nüksünün önlenmesi
için kısa süreli düşük doz hepatit B immünoglobulini ile nükleotid analoğunun birlikte kullanımının etkinliğini
belirlemek amaçlandı.
Gereç ve Yöntem: 01 Aralık 2017 ile 01 Eylül 2018 tarihleri arasında İstanbul Aydın Üniversitesi Sağlık Uygulama
ve Araştırma Hastanesi ve İstinye Üniversitesi Sağlık Uygulama ve Araştırma Hastanesi hastanelerinde Hepatit
B’ye bağlı siroz veya hepatosellüler kanser nedeniyle karaciğer nakli yapılmış hastalar retrospektif olarak
incelendi. Hastaların demografik bulguları, ameliyat öncesi viral belirteçleri, hepatosellüler kanser varlığı, HBV
DNA varlığı, kullanılan hepatit B immünoglobulin dozu, ameliyat sonrası HBsAg, Anti-HBs, HBV DNA düzeyleri
değerlendirildi.
Bulgular: Ortalama yaşı 54±11 (aralık; 30-69) olan toplam 17 hasta (3 kadın, 14 erkek) çalışmaya dâhil edildi.
Hastaların tümünün ameliyat öncesi HBsAg’si pozitif, 2 tanesinin ise HBV DNA’sı pozitifti. Ortalama takip süresi
16±3.3 ay (aralık; 12-22 ay) idi. Bu süreçte hiçbir hastada hepatit B nüksü gelişmedi.
Sonuç: Bu çalışmada kısa süreli düşük doz hepatit B immünoglobulini ile nükleotid analoğu kombinasyonunun
karaciğer nakli sonrası erken dönemde hepatit B nüksünü önlemede etkin olduğu görülmüştür. Bulgunun uzun
dönem sonuçlarıyla desteklenmesi gerekmektedir.
Anahtar kelimeler: Hepatit B immünoglobulini; Nükleotid analoğu; Karaciğer nakli; Hepatit B nüksü
ABSTRACT
Aim: The aim of this study was to determine the efficacy of low dose hepatitis B immunoglobulin and nucleotide
analog combination for prophylaxis to prevent recurrent hepatitis B infection after liver transplantation.
Material and Methods: Patients with hepatitis B associated liver disease who underwent liver transplantation
between 1 December 2017 and 1 September 2018 in Istanbul Aydın University Health Practice and Research
Hospital and Istinye University Health Practice and Research Hospital retrospectively evaluated. Demographic
data, preoperative viral markers, HBV DNA status, hepatocellular carcinoma status, dose of hepatitis B
immunoglobulin, postoperative HBs Ag, Anti Hbs, HBV DNA levels were recorded.
Results: Totally 17 patients (3 women, 14 men) with a mean age of 54±11 (range; 30-69) were evaluated. All
of the recipients preoperative HBs Ag were positive and HBV DNA was positive in only two recipients. Mean
follow-up was 16±3.3 (range; 12-22) months. There were no hepatitis B recurrence in this period.
Conclusion: This study showed that combination of low dose hepatitis B immunoglobulin and nucleotide
analog is an effective prophylaxis for recurrent hepatitis B infection for liver transplant recipients with HBVassociated
liver disease. This conclusion should be supported with long term results.
Key words: Hepatitis B immunoglobulin; Nucleotide analog; Liver transplantation; Hepatitis B recurrence
References
- 1. Teegen EM, Maurer MM, Globke B, Pratschke J, Eurich D. Liver transplantation for Hepatitis-B-associated liver disease - Three decades of experience. Transpl Infect Dis. 2019 Feb;21(1):e12997. doi: 10.1111/tid.12997. 2. Tozun N, Ozdogan OC, Cakaloglu Y, Idilman R, Karasu Z, Akarca U, et al. Seroprevalence of hepatitis B and C virüs infections and risk factors in Turkey: a fieldork TURHEP study. Clin Microbiol Infect 2015 July;21(11):1020-1026. 3. Idilman R, Akyildiz M, Keskin O, Gungor G, Yilmaz TU, Kalkan C, et al. The long-term efficacy of combining nucleos(t)ide analog and low-dose hepatitis B immunoglobulin on post-transplant hepatitis B virus recurrence. Clin Transplant 2016 Oct;30(10):1216-1221. doi: 10.1111/ctr.12804. 4. Lens S, García-Eliz M, Fernández I, Castells L, Bonacci M, Mas A, et al. Shorter hepatitis B immunoglobulin administration is not associated to hepatitis B virus recurrence when receiving combined prophylaxis after liver transplantation. Liver Int. 2018 Nov;38(11):1940-1950. doi: 10.1111/liv.13858. 5. Cholongitas E, Papatheodoridis GV. High genetic barrier nucleos(t)ide analogue(s) for prophylaxis from hepatitis B virus recurrence after liver transplantation: a systematic review.Am J Transplant. 2013 Feb;13(2):353-62. doi: 10.1111/j.1600-6143.2012.04315.x. 6. Gane EJ, Angus PW, Strasser S, Crawford DH, Ring J, Jeffrey GP, et al. Lamivudine plus low-dose hepatitis B immunoglobulin to prevent recurrent hepatitis B following liver transplantation. Gastroenterology. 2007 Mar;132(3):931-7. 7. Fung J, Chan SC, Cheung C, Yuen MF, Chok KS, Sharr W, et al. Oral nucleoside/nucleotide analogs without hepatitis B immune globulin after liver transplantation for hepatitis B. Am J Gastroenterol. 2013 Jun;108(6):942-8. doi: 10.1038/ajg.2013.111. 8. Gane EJ, Patterson S, Strasser SI, McCaughan GW, Angus PW. Combination of lamivudine and adefovir without hepatitis B immune globulin is safe and effective prophylaxis against hepatitis B virus recurrence in hepatitis B surface antigen-positive liver transplant candidates. Liver Transpl. 2013 Mar;19(3):268-74. doi: 10.1002/lt.23600. 9. Fung J, Wong T, Chok K, Chan A, Cheung TT, Dai JW, et al. Long-term outcomes of entecavir monotherapy for chronic hepatitis B after liver transplantation: Results up to 8 years. Hepatology. 2017 Oct;66(4):1036-1044. doi: 10.1002/hep.29191. 10. Akcam AT, Ulku A, Rencuzogullari A, Eray IC, Okoh A, Kuran S, et al. Antiviral Combination Therapy With Low-Dose Hepatitis B Immunoglobulin for the Prevention of Hepatitis B Virus Recurrence in Liver Transplant Recipients: A Single-Center Experience. Transplant Proc. 2015 Jun;47(5):1445-9. doi: 10.1016/j.transproceed.2015.04.018
Abstract
References
- 1. Teegen EM, Maurer MM, Globke B, Pratschke J, Eurich D. Liver transplantation for Hepatitis-B-associated liver disease - Three decades of experience. Transpl Infect Dis. 2019 Feb;21(1):e12997. doi: 10.1111/tid.12997. 2. Tozun N, Ozdogan OC, Cakaloglu Y, Idilman R, Karasu Z, Akarca U, et al. Seroprevalence of hepatitis B and C virüs infections and risk factors in Turkey: a fieldork TURHEP study. Clin Microbiol Infect 2015 July;21(11):1020-1026. 3. Idilman R, Akyildiz M, Keskin O, Gungor G, Yilmaz TU, Kalkan C, et al. The long-term efficacy of combining nucleos(t)ide analog and low-dose hepatitis B immunoglobulin on post-transplant hepatitis B virus recurrence. Clin Transplant 2016 Oct;30(10):1216-1221. doi: 10.1111/ctr.12804. 4. Lens S, García-Eliz M, Fernández I, Castells L, Bonacci M, Mas A, et al. Shorter hepatitis B immunoglobulin administration is not associated to hepatitis B virus recurrence when receiving combined prophylaxis after liver transplantation. Liver Int. 2018 Nov;38(11):1940-1950. doi: 10.1111/liv.13858. 5. Cholongitas E, Papatheodoridis GV. High genetic barrier nucleos(t)ide analogue(s) for prophylaxis from hepatitis B virus recurrence after liver transplantation: a systematic review.Am J Transplant. 2013 Feb;13(2):353-62. doi: 10.1111/j.1600-6143.2012.04315.x. 6. Gane EJ, Angus PW, Strasser S, Crawford DH, Ring J, Jeffrey GP, et al. Lamivudine plus low-dose hepatitis B immunoglobulin to prevent recurrent hepatitis B following liver transplantation. Gastroenterology. 2007 Mar;132(3):931-7. 7. Fung J, Chan SC, Cheung C, Yuen MF, Chok KS, Sharr W, et al. Oral nucleoside/nucleotide analogs without hepatitis B immune globulin after liver transplantation for hepatitis B. Am J Gastroenterol. 2013 Jun;108(6):942-8. doi: 10.1038/ajg.2013.111. 8. Gane EJ, Patterson S, Strasser SI, McCaughan GW, Angus PW. Combination of lamivudine and adefovir without hepatitis B immune globulin is safe and effective prophylaxis against hepatitis B virus recurrence in hepatitis B surface antigen-positive liver transplant candidates. Liver Transpl. 2013 Mar;19(3):268-74. doi: 10.1002/lt.23600. 9. Fung J, Wong T, Chok K, Chan A, Cheung TT, Dai JW, et al. Long-term outcomes of entecavir monotherapy for chronic hepatitis B after liver transplantation: Results up to 8 years. Hepatology. 2017 Oct;66(4):1036-1044. doi: 10.1002/hep.29191. 10. Akcam AT, Ulku A, Rencuzogullari A, Eray IC, Okoh A, Kuran S, et al. Antiviral Combination Therapy With Low-Dose Hepatitis B Immunoglobulin for the Prevention of Hepatitis B Virus Recurrence in Liver Transplant Recipients: A Single-Center Experience. Transplant Proc. 2015 Jun;47(5):1445-9. doi: 10.1016/j.transproceed.2015.04.018
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Original Research |
| Authors | |
| Publication Date | March 25, 2020 |
| Published in Issue | Year 2020 Volume: 10 Issue: 1 |