HBIG联合恩替卡韦用于HBsAg阳性受者接受HBsAg阳性供肾移植的临床观察

The combined HBIG and entecavir were applied into HBsAg positive receiver,which received kidney transplantation from HBsAg positive donor

目的探讨乙肝免疫球蛋白(HBIG)联合恩替卡韦预防乙肝表面抗原(HBsAg)阳性受者接受HBsAg阳性供肾移植后的疗效。方法回顾性分析2015年1月-2017年8月的30例肾移植病例的临床资料。其均为HBsAg阳性受者接受HBsAg阳性供肾,同时在供肾植入前,将HBIG 400 U注入100 ml HTK保存液中,并经肾动脉灌注入肾脏中,以及术后HBIG联合恩替卡韦预防策略。术后随访,评价移植肾、肝功能,检测乙肝DNA复制,并分析受者和移植物的存活率。结果截至2017年10月,随访3~36个月。受者存活率为100%,移植肾存活率为100%。术后3周时,丙氨酸转氨酶(ALT)为(67±17)U/L,天冬氨酸转氨酶(AST)为(53±12)U/L,血肌酐为(112±67.3)μmol/L,乙肝DNA为1×10~2~5×10~8拷贝/ml,2例患者HBV DNA拷贝数较前明显增加,1例患者进展为肝硬化代偿期,无急性肝衰竭和肝肿瘤发生。结论 HBsAg阳性受者可接受HBsAg阳性供肾,同时利用HBIG联合恩替卡韦预防,可有效控制乙肝短期爆发发生。

Objective To observe the effect of preventing the recurrence of hepatitis B with the combination entecavir and hepatitis B immune globulin（HBIG） in the hepatitis B surface antigen（HBsAg） positive renal transplant receipts,which received the HBsAg positive allograft. Methods The clinical data of 30 cases renal transplant were retrospectively analyzed from January 2015 to August 2017. To prevent outbreak of hepatitis B in the early time, the stategry was that the recipients with HBsAg positive received the allograft with hepatitis B positive. Prior to the transplantation,the 100 ml HTK preservation solution with HBIG 400 U was perfused into the kidney through the renal artery. In addition, entecavir was used for prophylaxis postoperatively. All of them were followed up for 3 to 36 months,the graft function, liver function, HBV DNA, and recipient and graft survival rates were evaluated. Results Up to October 2017,with 6 - 36 months follow-up,the one year survival of allograft was 100%. The one year survival of recipients was 100%. Post-transplantation 3 weeks,the liver function was ALT（67±17） U/L,AST（53±12） U/L. Serum creatine was（112±67.3） μmol/L and HBV DNA was 1×10^2- 5×10^8 copies/ml. HBV DNA increased significantly for two cases. One patients came to cirrhosis compensatory phase. There was no case with acute liver failure and liver tumor. Conclusion The HBIG plus entecavir in HBsAg positive recipients which received allograft from HBsAg positive donor can effectively prevent outbreak of hepatitis B in short term. The conclusion should be made by large clinical trials in the future.