小剂量HBIg联合核苷类似物预防肝移植术后乙肝复发1506例回顾性分析

目的 确定小剂量乙肝免疫球蛋白(HBIg)联合核苷类似物预防肝移植术后乙肝复发的效果.方法 对我院1998年12月至2009年11月间因乙肝相关性终末期肝病行肝移植手术并接受核苷类似物联合小剂量HBIg预防乙肝复发病例进行回顾性分析,调查其术前、术后乙肝相关检查、乙肝复发情况以及患者的生存情况.结果 在移植术后存活>30 d且获得随访(中位随访时间为27.8个月)的1506例患者中,术后出现乙肝复发者37例.术后1、2、3、4、5、6年累计复发率分别为1.3%、2.4%、2.7%、2.9%、3.7%、4.6%;术后乙肝复发时间为0.3～66.6个月(中位值为12.8个月).在37例乙肝复发患者中,9例检测出病毒变异,其中YMDD变异4例,YMDD+YIDD变异2例,YMDD+YVDD变异、YVDD变异、YIDD变异各1例.结论 肝脏移植为治疗乙肝相关性肝病的重要手段,术后采用核苷类似物联合小剂量HBIg可有效预防乙肝复发,乙肝复发患者及时采取挽救治疗可控制疾病,改善预后.

Abstract：

Objective To evaluate the preventive effect of combination of low-dose HBIg and Nucleoside analogues on recurrence of hepatitis B after liver transplantation. Methods Retrospectively analyzed HBV status and recurrence in patients accepting Nucleoside analogues plus low-dose HBIg as prophylaxis treatment after liver transplantation for HBV-related end-stage liver disease from December 1998 to Octomber 2009 in our center. Results In all the 1506 patients whose survival time >30 d after liver transplantation, 37 patients showed HBV recurrence, the HBV cumulative-recurrence rate of 1, 2, 3, 4, 5 and 6y was 1.3%,2. 4%,2. 7%,2. 9%,3. 7% and 4.6% respectively. The time of recurrence varied from 0. 3 to 66. 6 months (median 12. 8 months) after transplantation. Virus mutation could be tested in 9 cases of the 37 recurrence patients, including 4 YMDD cases, 2 YMDD + YIDD cases, 1 YMDD+YVDD cases, 1 YVDD case,and 1 YIDD case. Conclusions Liver transplantation is the principal therapeutic method for the patient with end-stage liver diseases related to HBV, with the effectively prophylaxis treatment to aim directly at HBV recurrence. If the patients who got HBV recurrence received targeted treatments, the situation can be controlled satisfactorily.

Combination of low-dose HBIg and Nucleoside analogues to prevent recurrent hepatitis B virus after liver transplantation: a retrospective analysis of 1506 cases

Objective To evaluate the preventive effect of combination of low-dose HBIg and Nucleoside analogues on recurrence of hepatitis B after liver transplantation. Methods Retrospectively analyzed HBV status and recurrence in patients accepting Nucleoside analogues plus low-dose HBIg as prophylaxis treatment after liver transplantation for HBV-related end-stage liver disease from December 1998 to Octomber 2009 in our center. Results In all the 1506 patients whose survival time >30 d after liver transplantation, 37 patients showed HBV recurrence, the HBV cumulative-recurrence rate of 1, 2, 3, 4, 5 and 6y was 1.3%,2. 4%,2. 7%,2. 9%,3. 7% and 4.6% respectively. The time of recurrence varied from 0. 3 to 66. 6 months (median 12. 8 months) after transplantation. Virus mutation could be tested in 9 cases of the 37 recurrence patients, including 4 YMDD cases, 2 YMDD + YIDD cases, 1 YMDD+YVDD cases, 1 YVDD case,and 1 YIDD case. Conclusions Liver transplantation is the principal therapeutic method for the patient with end-stage liver diseases related to HBV, with the effectively prophylaxis treatment to aim directly at HBV recurrence. If the patients who got HBV recurrence received targeted treatments, the situation can be controlled satisfactorily.