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Transpl Infect Dis ; 17(3): 329-33, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25682715

RESUMO

BACKGROUND: Low-dose hepatitis B immunoglobulin (HBIG) and nucleos(t)ides analogs (lamivudine/adefovir) used for the prevention of hepatitis B virus (HBV) recurrence after liver transplantation (LT) are associated with some risk of HBV recurrence and antiviral resistance. METHODS: The study cohort included 176 patients (at least >12 months follow-up) with HBV cirrhosis/hepatocellular carcinoma who received secondary prophylaxis with indefinite entecavir/tenofovir after living-donor LT (LDLT). All patients received 10,000 IU intravenous HBIG in anhepatic phase followed by 600-1000 IU intramuscularly daily for 7 days, weekly for 3 weeks, and then monthly, to keep antiHBs levels >100 mIU/mL for 1 year. Hepatitis B surface antigen (HBsAg) and HBV DNA were tested every 6 months. RESULTS: The study cohort is composed of 157 men and 19 women, mean age 47.9 ± 10.1 years, all HBsAg positive, 35 (19.8%) had HBV DNA >2000 IU/mL before LT. After LT, patients received entecavir (n = 126, 71.5%), tenofovir (n = 20, 11.3%), or a combination of entecavir and tenofovir (n = 30, 17% for 3 months), followed by entecavir alone. During follow-up of 43 (12-117) months, 2 patients (including 1 with non-compliance) had HBV recurrence. CONCLUSION: In a large cohort of LDLT recipients for HBV-related liver disease, use of low-dose short-term HBIG with high genetic barrier drugs results in a substantially lower incidence of HBV recurrence, even in high-risk patients.


Assuntos
Antivirais/administração & dosagem , Carcinoma Hepatocelular/prevenção & controle , Vírus da Hepatite B/imunologia , Hepatite B/prevenção & controle , Imunoglobulinas/administração & dosagem , Transplante de Fígado/efeitos adversos , Adenina/administração & dosagem , Adenina/análogos & derivados , Adulto , Carcinoma Hepatocelular/virologia , Estudos de Coortes , Farmacorresistência Viral , Quimioterapia Combinada , Feminino , Seguimentos , Guanina/administração & dosagem , Guanina/análogos & derivados , Hepatite B/virologia , Antígenos de Superfície da Hepatite B/imunologia , Vírus da Hepatite B/genética , Humanos , Lamivudina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Organofosfonatos/administração & dosagem , Estudos Prospectivos , Recidiva , Tenofovir/administração & dosagem
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