동종조혈모세포이식 후 B형간염의 혈청학적 표지자 변화
Change in the serologic markers of hepatitis B after allogenic hematopoietic stem-cell transplantation
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목적: 본 연구는 동종조혈모세포이식의 수혜자 및 제공자의 B형간염바이러스 감염과 면역 상태에 따라 이식 후 수혜자에서 일어나는 B형간염의 혈청학적 표지자 변화에 대해 알아보고자 하였다. 대상과 방법: 2000년 1월부터 2007년 6월까지 가톨릭대학교 의과대학 병원에서 백혈병, 악성 림프종, 및 고형암으로 동종조혈모세포이식을 시행한 환자는 537명이었다. 수혜자와 제공자에서 B형간염 표지자를 이식 전후로 검사하였고 평균 관찰기간은 36.6개월이었다(3～80개월). 결과: 동종조혈모세포이식을 시행받은 537명 중에 이식 전 혈청 HBsAg이 양성인 수혜자는 45명이었다. 그 중 21명이 혈청 anti-HBs가 양성인 제공자로부터 조혈모세포를 이식받았고, 24명은 anit-HBs가 음성인 제공자로부터 조혈모세포를 이식받았다. 전자의 경우 이식 후 21명 중 4명에서 HBsAg의 혈청전환이 일어난 반면, 후자에서는 이식 전후로 혈청학적 변화가 없었다. 이식 전 HBsAg 및 anti-HBs가 모두 음성인 수혜자가 혈청 anti-HBs가 양성인 제공자로부터 조혈모세포를 이식받은 경우 30명 중 15명에서 anti-HBs를 획득하였다(50%). 이식 전 혈청 anti- HBs를 보유하고 있었던 수혜자가 혈청 HBsAg이 음성이거나 anti-HBs가 양성인 제공자로부터 조혈모세포를 이식받은 경우 407명 중 8명에서 이식 후 혈청 HBsAg이 출현하였다. HBsAg 양성 제공자로부터 조혈모세포를 이식받은 41명의 환자에서 이식 전후로 B형간염 혈청표지자의 변화는 관찰되지 않았다. 결론: Anti-HBs 양성 제공자로부터 조혈모세포이식을 통해 전달된 양자면역에 의해 HBsAg 양성 수혜자의 일부에서 HBsAg의 혈청전환이 일어날 수 있으며, HBsAg 양성인 제공자가 수혜자의 B형간염 혈청표지자에 미치는 영향은 적었다. 하지만 HBV 만성 감염자 혹은 감염 경력이 있는 자를 수혜자 혹은 제공자로 하는 조혈모세포이식에서는 이식 과정 중 수반되는 면역억제로 인해 B형간염이 재활성화 될 수 있으므로 이에 대한 적절한 예방책이 필요하다.
Abstract
Backgrounds/Aims: This study examined the effects of hepatitis B virus (HBV) infection state and immunologic capability in both the recipients and donors of allogenic hematopoietic stem-cell transplantation (allo-HSCT) on changes in HBV serologic markers in recipients. Methods: A total of 537 patients underwent allo-HSCT for the treatment of leukemia, malignant lymphoma, and solid tumor. HBV serologic markers were examined in both recipients and donors prior to and following the transplantation. The mean follow-up period was 36.6 months (range 3-80 months). Results: Of the 537 patients who underwent allo-HSCT, 45 recipients were positive for HBsAg prior to transplantation. Of these 45 patients, 21 were transplanted from anti- HBs-positive donors and the remaining 24 were transplanted from anti-HBs-negative donors. In the former cases, seroconversion was noted in 4 of the 21 patients (19%). In the latter cases, however, no seroconversion was noted following the transplantation. Thirty patients who were negative for both HBsAg and anti-HBs were transplanted from anti-HBs-positive donors, and 15 out of 30 patients (50%) acquired anti-HBs. Four hundred and seven patients who were positive for anti-HBs were transplanted from anti-HBs-positive or HbsAg-negative donors; 8 of these proved HBsAg-positive following the transplantation. There were no changes in HBV serological markers following transplantation in 41 patients who were transplanted from HbsAg-positive donors. Conclusions: Due to the adoptive immunity that was transferred from anti-HBs- positive donors, a seroconversion of HBsAg could occur in some HBsAg-positive recipients. HBsAg-positive donors had a lesser effect on the HBV serologic markers of recipients. However, a reactivation of HBV can occur following hematopoietic stem-cell transplantation in the cases of recipients or donors with a history of HBV, infection by an accompanying immune suppression. Therefore, prevention should be instigated.
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