乙型肝炎相关性肝病肝移植术后的急性排斥反应

目的 研究乙型肝炎相关性肝病肝移植术后急性排斥反应的发病率、治疗和预防。方法前瞻性地研究用肝移植术治疗乙型肝炎相关性肝病100例，分析急性排斥反应的发病相关因素，急性排斥反应和免疫抑制剂治疗的动态监测及二者间的联系。结果临床型急性排斥反应的发病率为12％，急性排斥反应发生前3～5d，有明显的免疫抑制剂浓度降低的过程。FKS06为基础的免疫抑制方案，加用骁悉，可有效地终止、逆转急性排斥反应；和以甲基强的松龙冲击治疗急性排斥反应相比较，副作用少，但肝功能的完全恢复时间相对较慢。结论乙型肝炎相关性肝病的肝移植术后急性排斥反应的发生率相对较低；和急性排斥反应发生相关的免疫抑制剂低浓度是诱导急性排斥反应的重要相关因素；FK506为基础的免疫抑制方案，可有效地终止、逆转急性排斥反应，且副作用少。

Acute rejection after orthotopic liver transplantation in recipients with hepatitis B related liver diseases

Objective To determine the incidence,treatment and prevention of early acute re- jection after orthotopic liver transplantation(OLT)for treatment of hepatitis B related liver diseases. Methods The morbidity of early acute rejection after OLT in 100 patients with hepatitis B related liv- er diseases was prospectively studied by analyzing the rejection-related factors and the relationship be- tween blood immunosuppressant level and early acute rejection.Results The incidence of early acute rejection after OLT was 12%.There was significantly low blood immunosuppressant level 2-5 d prior to the occurrence of early acute rejection.FK506 as the baseline immunosuppressant with mycopheno- late mofetil could successfully reverse the early acute rejection with fewer side effects but longer time for complete recovery as compared with the treatment with pulse of methylprednisolone.Conclusions The incidence of early acute rejection after OLT is relatively low.Lower blood immunosuppressant level is an important factor in inducing the early acute rejection.FK506 as the baseline immunosup- pressant with mycophenolate mofetil can successfully reverse the early acute rejection with fewer side effects.