肝移植术后乙肝主动免疫重建受体停用乙肝免疫球蛋白和(或)抗病毒药物的可行性

The feasibility of HBIG and (or) antiviral agents withdrawing in liver transplant recipients with hepatitis B immune reconstitution

目的探讨乙肝肝移植术后乙肝主动免疫重建成功受体停用乙肝免疫球蛋白(HBIG)和(或)抗病毒药物的可行性及临床指征。方法检测乙肝主动免疫重建成功受体体内的HBV DNA和ccc DNA的水平,并监测其停用HBIG和(或)抗病毒药物后的乙肝复发情况。结果共20例乙肝主动免疫重建成功受体纳入本研究。所有受体血浆均未检测到HBV DNA,1例受体的外周血单个核细胞中检测出微量HBV DNA(0.023 6 copies/cell),另1例受体的肝组织中检测出微量HBV DNA,但均未检测到ccc DNA。随访期间,所有受体均停用HBIG,13例停用抗病毒药物。1例外周血单个核细胞中检测到HBV DNA的受体有乙肝复发,并检测出HBV变异(变异位点G145R)。结论乙肝肝移植术后乙肝主动免疫重建成功受体停用HBIG和(或)抗病毒药物是安全可行的,但必须在停药前检测体内的HBV和病毒变异情况。

Objective To investigate the feasibility and indication of hepatitis B immunoglobulin（HBIG） and（or）antiviral agent withdrawing in liver transplant recipients with active hepatitis B immune reconstitution against HBV reinfection. Methods The level of HBV DNA and ccc DNA in peripheral blood mononuclear cells（PBMCs）, liver biopsy tissues and serum were detected in the responders with active hepatitis B immune reconstitution by real-time PCR. Hepatitis B recurrences were monitored for the responders after the withdrawal of HBIG and（or）antiviral agents. Results Twenty responders were enrolled into the study. The HBV DNA level of all the responders was not detected in serum. One was detected to have HBV DNA（0.023 6 copies/cell） in PBMCs and another was detected to be HBV DNA positive in the liver tissue of eighteen patients, but no ccc DNA was detected in both. During the following-up, all the responders withdrawn HBIG and thirteen withdrawn antiviral agents. One responder who was detected to have HBV DNA in PBMCs suffered HBV reinfection and had HBV mutation（G145R）. Conclusion It is safe and feasible to withdraw HBIG and（or） antiviral agents before the detection of HBV as well as its mutations in liver transplant recipients.