Effectiveness of Posttransplant Prophylaxis With Anti-Hepatitis B Virus Immunoglobulin in Recipients of Heart Transplant From Hepatitis B Virus Core Antibody Positive Donors
Notice bibliographique
Résumé
Organ shortage remains a major problem in heart transplantation (HTx). In the past, donors who tested positive for hepatitis B virus (HBV) were removed from the pool because of the risk of HBV transmission to naïve recipients. Because hepatitis B remains widespread with 2 billion people infected worldwide, the use of expanded criteria donors has been reexamined. In one study, the use of organs from HBsAg−/ HBcAb+ donors resulted in 43% transmission of HBV in naïve liver recipients, while no transmission was observed in kidney or heart recipients (1). The course of de novo HBV infection was studied in 69 patients after HTx. The majority of the patients developed chronic hepatitis resulting in liver cirrhosis in 55% and death in 45.9% of the patients, respectively (2). In liver transplantation, it was shown that despite ongoing HB immunoglobulin (HBIg) administration, 15% to 50% of patients developed recurrent HBV likely due to escape mutations (3). Therefore, a combination of HBIg with nucleoside analogs has been evaluated to decrease the risk of HBV transmission from HBsAg−/HBcAb+ donors (4–6). Of 33 HTx recipients of HBsAg−/HBcAb+ donors, none of five patients receiving HBV prophylaxis with Lamivudine experienced seroconversion but one patient not receiving prophylaxis developed HBV infection (7). Between January 1998 and August 2001, 3 (HBV naïve) of 58 adult HTx received hearts from HBsAg−/HBcAb+ donors. Immunosuppression consisted of induction therapy with anti-thymocyte globulin in two patients and daclizumab in one patient, mycophenolate mofetil, cyclosporine microemulsion, and prednisone. All patients received HBIg (human hepatitis B immunoglobulin; BayHep B, Bayer Corporation) prophylaxis (intramuscular injections of 10 mL daily during the first 2 weeks postHTx, weekly for 1 month, and then every 6–12 weeks). We aimed for an HBsAb titer >250 IU/L. The use of HBIg was well tolerated without evidence of side effects. Liver function tests remained normal throughout a follow-up period of 7 years in two patients and 5 years in one. HBV serologies and HBV DNA polymerase chain reaction remained negative, and their HBsAb titers remained >250 IU/L. The use of hepatitis B vaccination prior to HTx increases the utilization of HBcAb+ donors (8). However, the rate of response to HBV vaccination is poor in sicker patients (8), it may not be feasible in case of emergency HTx and/or lack of completion of the vaccination schedule. Hence, there is a cluster of HTx recipients who are serologically naïve and who require other strategies for HBV prophylaxis. Our HBIg prophylaxis protocol was based in our liver transplant experience using HbcAb+ donors, at the time that the use of Lamivudine was not widely accepted. In HTx patients who are HBsAb−, preoperative and (if necessary) postoperative vaccination should be considered. However, one study, reported a seroconversion rate of 12.9% and it has been suggested to administer HBIg until an HBsAb titer >100 IU/L is achieved (9). Our report has the limitations of a small study involving only three subjects. However, our results suggest that HBIg may be effective to prevent HBV infection in naïve HTx recipients from HBcAb+ donors. Maria Krassilnikova Department of Medicine Royal Victoria Hospital McGill University Health Center McGill University Montréal, Québec, Canada Marc Deschenes Department of Medicine Royal Victoria Hospital McGill University Health Center McGill University Montréal, Québec, Canada Jean Tchevenkov Department of Surgery Royal Victoria Hospital McGill University Health Center McGill University Montréal, Québec, Canada Nadia Giannetti Department of Medicine Royal Victoria Hospital McGill University Health Center McGill University Montréal, Québec, Canada Renzo Cecere Department of Cardiovascular and Thoracic Surgery Royal Victoria Hospital McGill University Health Center McGill University Montréal, Québec, Canada Marcelo Cantarovich Department of Medicine Royal Victoria Hospital McGill University Health Center McGill University Montréal, Québec, Canada
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».