Research About The Prevention And Treatment Of HBV Reinfection After Liver Transplantation

Objective:Liver transplantation(LT) is the best therapeutic option for a patient who is at the late phase of a hepatic disease.In our country,acute or chronic HBV-related end-stage liver diseases serve as the main indication of the liver transplantation,which is likely to bring about the reinfection of HBV post-LT.The reinfection of HBV is the main factor that affects the survival rate of the patients post-LT.Using combination prophylaxis with high-dose hepatitis B immunoglobulin(HBIg) and lamivudine,the rate of reinfection HBV can be reduced and the survival rate improved.However,cost of long-term prophylaxis with high-dose HBIg is very expensive.The combination of lower-dose HBIg and lamivudine has been used by us,and the outcome is satisfactory as well.Compared with the alien multicenter,this study aimed to evaluate the efficacy of the combination of lamivudine and lower-dose HBIg made in China.Method:27 patients with HBV-related diseases,including 5 patients with primary hepatic cell carcinoma and 22 patients with benign end-stag hepatic diseases,received the combination of lower-dose HBIg and lamivudine as prophylaxis for HBV reinfection post-LT and were followed up for more than 6 months.During the time of follow-up, virological and biochemical data ,HBV DNA in serum,and immunohistological stain for HBsAg and HBcAg in biopsy liver tissue were tested in due time.The result of middle phase,over a half year,is used to compared with the result observed by the alien multicenter.Results:After a median follow-up of 15.3 months,none of 27 patients in the clinical experiment group is reinfected with HBV and the rate of HBV reinfection post-LT is 0%. 11 of 204 patients in the history control group is reinfected with HBV and the rate of reinfection HBV is 5.4%.Ruling out 6 patients with YMDD mutation pre-LT, the rate of reinfection HBV is 2.5%.The data of the groups are tested by x2 and there is not significant difference because of P>0.05.Conclusions:Compared with the combination of lamivudine and high-dose HBIg, the combination of lamivudine and lower-dose HBIg to prevent HBV reinfection is safe,cost-effective.The regime is beneficial to generalize and utilize.Because of the higher rate of HBV reinfection and the worse prognosis,the patients with YMDD mutation pre-LT need a effective prevention and cure regime that should be studied and researched further.The use of lamivudine and HBIg should be individualized.