title: Effectiveness of prophylactic Anti-HBV therapy in allogeneic hematopoietic stem cell transplantation with HBsAg positive donors.
abstract: Use of hepatitis B surface antigen (HBsAg) positive donors for allogeneic hematopoietic stem cell transplantation (HSCT) causes serious hepatitis B virus (HBV)-related liver morbidity and mortality in the recipient. We compared the effectiveness of anti-HBV therapy in 29 recipients who underwent HSCT using HBsAg positive marrow (group I) against a historical control group of 25 patients who received HBsAg positive marrow without pre-HSCT prophylaxis (group II). Anti-HBV therapy consisted of lamivudine for HBsAg-positive donors and all recipients (n = 29) as well as HBV vaccination to all HBsAg-negative recipients (n = 10) before HSCT. After transplantation, HBV-related hepatitis was significantly higher in group II than group I recipients [12 of 25 recipients (48%) vs. 2 of 29 recipients (6.9%), p = 0.002] and in recipients whose donors had detectable serum HBV DNA by Digene Hybrid Capture II assay [8 of 14 recipients (57.1%) vs. 6 of 40 recipients (15.0%), p = 0.02]. Six recipients in group II and none in group I died of HBV-related hepatic failure (24.0% vs. 0%, p = 0.01). By multivariate Cox analysis, anti-HBV therapy effectively reduces post-HSCT HBV-related hepatitis (p = 0.01, adjusted hazards ratio 7.27, 95%CI 1.62-32.58). Our data support the use of prophylactic therapy in preventing HBV-related hepatitis after allogeneic HSCT from HBsAg-positive donor.
authors.affiliation: Division of Gastroenterology and Hepatology, The University of Hong Kong, China.
authors.forename: Chee-kin
authors.initials: CK
authors.lastname: Hui
authors.forename: Albert
authors.initials: A
authors.lastname: Lie
authors.forename: Wing-yan
authors.initials: WY
authors.lastname: Au
authors.forename: Shing-yan
authors.initials: SY
authors.lastname: Ma
authors.forename: Yu-Hung
authors.initials: YH
authors.lastname: Leung
authors.forename: Hai-ying
authors.initials: HY
authors.lastname: Zhang
authors.forename: Jian
authors.initials: J
authors.lastname: Sun
authors.forename: Winnie W W
authors.initials: WW
authors.lastname: Cheung
authors.forename: Chor-sang
authors.initials: CS
authors.lastname: Chim
authors.forename: Yok-lam
authors.initials: YL
authors.lastname: Kwong
authors.forename: Raymond
authors.initials: R
authors.lastname: Liang
authors.forename: George K K
authors.initials: GK
authors.lastname: Lau
mesh_terms: D000328:Adult; D019072:Antibiotic Prophylaxis; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006514:Hepatitis B Surface Antigens / Q000276:immunology*; D006515:Hepatitis B virus / Q000502:physiology*; D019694:Hepatitis B, Chronic / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D014019:Tissue Donors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D006514:Hepatitis B Surface Antigens; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine