TY - JOUR
T1 - Nationwide prospective and retrospective surveys for hepatitis B virus reactivation during immunosuppressive therapies
AU - Mochida, Satoshi
AU - Nakao, Masamitsu
AU - Nakayama, Nobuaki
AU - Uchida, Yoshihito
AU - Nagoshi, Sumiko
AU - Ido, Akio
AU - Mimura, Toshihide
AU - Harigai, Masayoshi
AU - Kaneko, Hiroshi
AU - Kobayashi, Hiroko
AU - Tsuchida, Tetsuya
AU - Suzuki, Hiromichi
AU - Ura, Nobuyuki
AU - Nakamura, Yuichi
AU - Bessho, Masami
AU - Dan, Kazuo
AU - Kusumoto, Shigeru
AU - Sasaki, Yasutsuna
AU - Fujii, Hirofumi
AU - Suzuki, Fumitaka
AU - Ikeda, Kenji
AU - Yamamoto, Kazuhiko
AU - Takikawa, Hajime
AU - Tsubouchi, Hirohito
AU - Mizokami, Masashi
N1 - Publisher Copyright:
© 2016, Japanese Society of Gastroenterology.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Background: The significance of HBV reactivation during immunosuppressive therapy was evaluated in three nationwide cohorts including patients with previously resolved HBV (prHBV) infection. Methods: The clinical features of 1061 patients with acute liver failure (ALF) or late-onset hepatic failure (LOHF) were retrospectively examined, focusing on those who experienced HBV reactivation. Additionally, 420 patients with prHBV infection were prospectively enrolled: 203 received immunosuppressive therapies immediately after enrollment, while the remaining 217 were enrolled after having received immunosuppressive therapies without the occurrence of HBV reactivation. The serum HBV-DNA levels were prospectively monitored every month, and the incidences of HBV reactivation, defined as a serum HBV-DNA level of 1.3 log IU/ml or more, were evaluated. Results: In the retrospective study, persistent HBV infection was found in 90 patients, and HBV reactivation was responsible for liver injuries in 50 patients including 23 receiving immunosuppressive therapies (26 with HBs-antigen positivity, 7 with prHBV infection). None of seven patients with prHBV infection were rescued. In the prospective studies, HBV reactivation occurred in ten patients, but preemptive entecavir administration prevented liver injury. The cumulative reactivation rate was 3.2 % at 6 months, and the increase of the rate compared to that at 6 months was +1.5 % at 48 months. Conclusions: HBV reactivation during immunosuppression was responsible for liver injuries in a quarter of the ALF/LOHF patients with persistent HBV infection. Early serum HBV-DNA monitoring may improve patient prognosis, since HBV reactivation typically occurs within 6 months of the start of immunosuppressive therapies in patients with prHBV infection.
AB - Background: The significance of HBV reactivation during immunosuppressive therapy was evaluated in three nationwide cohorts including patients with previously resolved HBV (prHBV) infection. Methods: The clinical features of 1061 patients with acute liver failure (ALF) or late-onset hepatic failure (LOHF) were retrospectively examined, focusing on those who experienced HBV reactivation. Additionally, 420 patients with prHBV infection were prospectively enrolled: 203 received immunosuppressive therapies immediately after enrollment, while the remaining 217 were enrolled after having received immunosuppressive therapies without the occurrence of HBV reactivation. The serum HBV-DNA levels were prospectively monitored every month, and the incidences of HBV reactivation, defined as a serum HBV-DNA level of 1.3 log IU/ml or more, were evaluated. Results: In the retrospective study, persistent HBV infection was found in 90 patients, and HBV reactivation was responsible for liver injuries in 50 patients including 23 receiving immunosuppressive therapies (26 with HBs-antigen positivity, 7 with prHBV infection). None of seven patients with prHBV infection were rescued. In the prospective studies, HBV reactivation occurred in ten patients, but preemptive entecavir administration prevented liver injury. The cumulative reactivation rate was 3.2 % at 6 months, and the increase of the rate compared to that at 6 months was +1.5 % at 48 months. Conclusions: HBV reactivation during immunosuppression was responsible for liver injuries in a quarter of the ALF/LOHF patients with persistent HBV infection. Early serum HBV-DNA monitoring may improve patient prognosis, since HBV reactivation typically occurs within 6 months of the start of immunosuppressive therapies in patients with prHBV infection.
KW - Acute liver failure
KW - De novo hepatitis B
KW - HBV reactivation
KW - Immunosuppressive therapy
UR - http://www.scopus.com/inward/record.url?scp=84988864309&partnerID=8YFLogxK
U2 - 10.1007/s00535-016-1168-2
DO - 10.1007/s00535-016-1168-2
M3 - 記事
C2 - 26831356
AN - SCOPUS:84988864309
SN - 0944-1174
VL - 51
SP - 999
EP - 1010
JO - Journal of Gastroenterology
JF - Journal of Gastroenterology
IS - 10
ER -