| 特集名 | 肝移植 ― 現状と展望 | |
|---|---|---|
| 題名 | B型肝炎，肝硬変に対する肝移植 | |
| 発刊年月 | 2013年 08月 | |
| 著者 | 尾上 隆司 | 広島大学大学院医歯薬保健学研究院応用生命科学部門消化器・移植外科／国立病院機構呉医療センター／中国がんセンター臨床研究部 |
| 著者 | 高橋 祥一 | 広島大学大学院消化器・代謝内科学 |
| 著者 | 茶山 一彰 | 広島大学大学院消化器・代謝内科学 |
| 著者 | 大段 秀樹 | 広島大学大学院消化器・代謝内科 |
| 【 要旨 】 | B型肝炎関連肝疾患に対し，肝移植はきわめて有効な治療法であるが，術後肝炎再発が問題となる．現在は，移植術前からの核酸アナログ製剤の投与，術中HBIG投与，術後併用投与が標準的予防法として確立し，B型肝炎に対する肝移植成績は著明に向上している．この方法は肝移植後de novo B型肝炎発症予防にも有効だが，標準化にはさらなる検討が必要である． 医療経済および安全性の面で，HBワクチンを用いた能動免疫獲得は理想的であるが，従来奏効率は低かった．しかし免疫モニタリングを利用した移植後の免疫状態適正化およびHBワクチン長期投与により，効果的な能動免疫誘導およびHBIGと核酸アナログ製剤からの離脱が可能である． |
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| Theme | Liver Transplantation -- Current Status and Perspective | |
|---|---|---|
| Title | Liver Transplantation for HBV-related Liver Disease | |
| Author | Takashi Onoe | Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University / Institute for Clinical Research, National Hospital Organization, Kure Medical Center / Chugoku Cancer Cent |
| Author | Shoichi Takahashi | Department of Gastroenterology and Metabolism, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University |
| Author | Kazuaki Chayama | Department of Gastroenterology and Metabolism, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University |
| Author | Hideki Ohdan | Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University |
| [ Summary ] | Liver transplantation (LT) is highly effective for patients with end-stage hepatitis B virus (HBV)-related liver disease. Nonetheless, HBV infections often recur after LT without prophylaxis. Currently, a combination therapy involving a nucleotide analog and hepatitis B immunoglobulin (HBIG) has been established as the standard prophylaxis for post-LT HBV reinfection. It has been shown to provide marked improvements in patient survival rates. This prophylactic therapy has also been shown to be effective for treatment of de novo hepatitis B in recipients who have received grafts from HBcAb-positive donors. However, the regimen presently varies from institute to institute and a standardized regimen remains to be established. Because this prophylactic regimen is costly and does not guarantee safety after long-term use, active immunization with an HBV vaccine post-LT is a preferable alternative. However, it has been reported that patients showed poor response to vaccinations because of the immunosuppressive environment (response rate：approximately 10 %) induced post-LT. We scheduled mixed-lymphocyte reaction assays to monitor patientsʼ immune status and to minimize immunosuppression, and performed unlimitedly repeated vaccinations. The overall response rate for vaccinations was 65 %. Patients who exhibited responses were safely weaned off HBIG and/or nucleotide analogs in our institute. Thus, minimizing immunosuppression to induce an antidonor-specific immunosuppressive status should enable post-LT HBV vaccinations to become a promising prophylactic strategy. |
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