肝移植后乙型肝炎复发的临床与病理特点分析

目的探讨我国乙型肝炎（乙肝）相关性肝移植有效预防后,乙肝复发的临床规律、特点及与病理改变的相关性。方法回顾性分析2007年6月-20HD9年8月我院移植内科收治的16例确诊为术后乙肝复发患者的临床和病理资料。结果复发时间为术后4～48（21．2±13．2）个月。16例中有12例在服用拉米夫定8～46个月出现YMDD变异,2例肿瘤复发行化疗后乙肝复发,2例在服用拉米夫定2年停用后复发。临床类型包括：①纤维化胆汁淤积型肝炎1例,病情凶险,病死率高。②慢性肝炎15例,其中轻度慢性肝炎8例,中度慢性肝炎6例,重度慢性肝炎1例;病理诊断为轻、中度的分别有13、2例。11例临床与病理诊断相符,其中8例临床与病理均诊断为慢性肝炎轻度。4例伴BanffI-I级急性排异反应。3例伴轻度药物性肝损伤。早期抗病毒治疗后预后良好。结论肝移植后乙肝复发多发生在移植术后2年内。YMDD变异是肝移植后乙肝复发的主要原因,化疗亦易致乙肝复发。肝移植术后应长期抗病毒治疗。乙肝相关性肝移植后乙肝复发病毒载量高,临床表现及病理损害重。

Clinical and pathological analysis of hepatitis B recurrence following liver transplantation

Objective To investigate the clinical characteristics of recurrent hepatitis B following liver transplantation while effective preventive measures were taken and the correlation with pathological examination. Methods The clinical and pathological data of 16 patients admitted to our hospital from Jun. 2007 to Aug. 2009, who developed hepatitis B recurrence following liver transplantation, were analyzed retrospectively. Results The recurrence of hepatitis B occurred 4 to 48 （21.2＋ 13.2） months after liver transplantation. YMDD mutation was identified in 12 patients after taking lamivudine for 8 to 46 months. Two patients developed hepatitis B recurrence after receiving chemotherapy when hepatocellular carcinoma recurred, and 2 developed the recurrence after the withdrawal of lamivudine which had been used for 2 years. One patient was diagnosed with fibrosing cholestatic hepatitis, which was in serious condition with high mortality. Fifteen patients were diagnosed with chronic hepatitis, 8 with mild chronic hepatitis, 6 with moderate chronic hepatitis and 1 with severe chronic hepatitis. Mild chronic hepatitis was identified in 13 patients and moderate chronic hepatitis in 2 by liver biopsy. Clinical diagnosis in 11 patients was the same as pathological diagnosis, 8 with mild chronic hepatitis. Acute cellular rejection with Banff I-- I was seen in 4 patients and drug-induced liver damage in 3. The patients had good prognosis after early antiviral treatment. Conclusions Hepatitis B recurrence often develops in the 2 years following liver trans- plantation. YMDD mutation is a major cause of the recurrence following liver transplantation, and chemotherapy is likely to result in the recurrence. Long-term antiviral treatment is needed after liver transplantation. The patients with recurrent hepatitis B following liver transplantation have higher viral loads, more severe clinical manifestations and greater pathological damage.