肝移植治疗乙肝相关疾病

目的 总结原位肝移植（OLT）治疗乙肝相关疾病的疗效,并评价了拉米夫定对肝移植术后乙肝复发的防治作用。方法 自1993年4月-2000年12月,中山医科大学器官移植中心为54例乙肝相关疾病患者实施了肝移植,其中乙肝坏死后肝硬化17例,为第1组,25例同时合并肝癌者为第2组、其余12例暴发性肝功能衰竭患者为3组。回顾性地分析了3组患者术后存活率、早期死亡原因以及拉米夫定对术后乙肝复发的防治情况。结果 乙肝相关疾病患者肝移植术后早期存活率为75.9%,暴发性肝衰组患者术后早期并发症发生率明显高于其它2组;OLT对小肝癌患者的疗效明显优于大肝癌患者;拉米夫定防治乙肝复发辣效好且未发现副作用。结论 结合拉米夫定,OLT是治疗暴发性乙肝、乙肝肝硬化及小肝癌甚或某些选择性大肝癌患者的有效手段。

Liver transplantation for patients with hepatitis B virus-related diseases

Objectives To summarize the results of the orthotopic liver transplantation (OLT) for HBV-related diseases and assess the efficiency of lamivudine on preventing HBV recurrence. Methods From April 1993 to December 2000, 54 patients with HBV-related liver disease were treated by OLT at the Transplantation Center of Sun Yet-sen University of Medical Sciences (SUMS). Seventeen patients who had postnecrotic cirrhosis (PNC) as a result of HBV infection were designated as group 1; 25 patients coexisting hepatocellular carcinoma (HCC) served as group 2; the remaining 12 patients who had no liver disease but fulminant hepatic failure (FHF) due to HBV infection served as group 3. The survival rate, the causes of early death and the HBV recurrence rate under lamividine monotherapy were retrospectively analyzed. Results The overall survival rate within 2 months of transplantation was 75 9% and the morbidity in group 3 was obviously higher than in group 1 and group 2;the outcome of patients with small HCC was superior to that of patients with large HCC; lamivudine monotherapy can effectively prevent and treat HBV recurrence while no side effect attributable to it had been identified. Conclusion Combined with the use of lamividine, liver transplantation can be justified in patients with fulminant hepatitis B, hepatitis B-related liver cirrhosis and coexisting small HCC or even selected large HCC.