Yaşar TUNA, Erhan ALKAN, Halil ERBİŞ, Fuat EKİZ, Mahmut AKYOL, Ömer BAŞAR

Prevention of Hepatitis B Recurrence in Liver Transplant Patients Using Oral Antiviral Therapy with Long-Term Low and High Dose Hepatitis B Immunoglobulin

Hepatit B virus (HBV) ilişkili orthotropik karaciğer transplant (OLT) alıcıları, post-operatif HBV enfeksiyonu için yüksek riske sahiptir. Hepatit B immunglobulin (HBIG) ve nucleos(t)ide kombinasyon profilaksi tedavisi, OLT sonrası HBV enfeksiyonuna karşı güncel olarak önerilmektedir. Buna karşın optimal protokol konusu tartışmalıdır. Bu çalışmada amaç; organ nakli merkezinde OLT sonrası uzun dönem nucleos(t)ide analoğu ve düşük ve yüksek doz HBIG tedavi profilaksi alan hastalarda HBV enfeksiyonu sonuçlarının araştırılmasıdır. Materyal ve Metot: Akdeniz Üniversitesi Organ Nakli Merkezinde 2010-2012 yılları arasında OLT olan 42 HBV hastası incelenmiştir. Anhepatik fazda 24 hasta düşük doz (2 000 IU IV) HBIG ve 18 hastada yüksek doz (10 000 IU IV) HBIG almıştır. Uzun dönemde hastalar 2 gruba bölünmüştür. Birinci gruba Hepatit B yüzey antikor titresi 100 IU/dl den fazla olan, ikinci gruba 100 IU/dlden düşük olan hastalar alındı. Bulgular: 24 hasta düşük doz HBIG ve 18 hasta yüksek doz HBIG proflaksisiyle uzun dönem tedavi edilmiştir. 4 hasta ise HBIG proflaksisine devam edememiştir. 4 hastanın üçünde HBV enfeksiyonu ortaya çıkmıştır. Hastalar ortalama 33 ay (2-110 ay) takip edilmiş, 4 hastada HBV enfeksiyonu tekrar etmiştir. Yüksek doz HBIG ve oral antiviral ajan alan hastaların OTL sonrası HBV tekrarlama frekansı daha düşüktür. Sonuçlar: Nükleosi(t)de analog tedavisi post-LT HBV enfeksiyon tekrarlarının önlenmesinde etkili ve güvenlidir. Bununla birlikte HBV proflaksisinde yüksek doz HBIG ve nüklesi(t)de anti-viral ajanların kombinasyon tedavisi OLT sonrası HBV enfeksiyon tekrarlama riskini belirgin düşürmektedir.

(Karaciğer nakli yapılan hastalarda Hepatit B nüksünü engellemek amacıyla kullanılan oral antiviral tedaviye eklenen Hepatit B immunoglobulin tedavisinin düşük doz uzun dönem ile yüksek dozunun karşılaştırılması)

Background: Hepatitis B virus (HBV) related orthotropic liver transplant (OLT) recipients have a high risk of HBV reinfection in the absence of continuous post-operative HBV prophylaxis. The combination of hepatitis B immune globulin (HBIG) and nucleos(t)ide agents is currently recommended as prophylaxis against the recurrence of HBV after OLT. However optimal protocol is a matter of controversy. The aim of this study was to investigate the efficacy of nucleos(t)ide analogue with long-term low and high dose HBIG therapy after OLT at a single organ transplant center. Material and Methods: Forty-two HBV patients undergoing OLT at a transplant center of Akdeniz University between 2000 and 2012 were evaluated. 24 patients received low-dose (2 000 IU) IV HBIG, 18 Patients received high dose (10 000 IU) IV HBIG in anhepatic phase. In long-term period patients were divided into two groups. First group of patients had hepatitis B surface antibody titers more than 100 IU/dl HBIG and second group of patients had less than 100 IU/dl HBIG titers. Results: Twenty-four patients were treated with low dose HBIG, on the other hand 18 patients were treated with high dose HBIG prophylaxis in the follow-up period. Four patients could not continue the HBIG prophylaxis. In three of four patients, HBV appeared. At a median time of 33 months (range 2-110 months) post-LT, 4 of the 38 patients had recurrent HBV infection. Patients receiving high dose HBIG and an oral antiviral agent have a lower frequency of HBV recurrence after OLT. Conclusions: Nucleosi(t)de analogue therapy was effective and safe to prevent post-LT HBV recurrence. However, combination of long-term high dosage of HBIG and nucleos(t)ide antiviral agents for HBV prophylaxis significantly reduces the risk of HBV recurrence after OLT.

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