肝移植后乙型肝炎复发的危险因素及预后分析

目的探讨乙型肝炎相关性肝移植患者术后在核苷(酸)类似物联合小剂量乙型肝炎免疫球蛋白的预防下乙型肝炎复发的危险因素及预后。方法 253例乙型肝炎相关性肝移植患者术前即开始给予核苷(酸)类似物预防,术中和术后均给予核苷(酸)类似物联合乙型肝炎免疫球蛋白处理。结果在253例肝移植患者中,死亡29例(11.5%);术前基础病为HBV相关性肝癌患者的病死率为21.2%,显著高于非肝癌患者的5.2%(P=0.000);乙型肝炎复发16例(6.3%);复发后均停用乙型肝炎免疫球蛋白,并调整核苷(酸)类似物,结果患者HBV DNA均<500IU/ml,肝功能稳定;Log-rank检验显示乙型肝炎复发后及时治疗对患者生存无明显影响;经Logistic多因素回归分析表明,术前HBeAg阳性、HBV DNA≥105IU/ml、HCC和HBV/YMDD变异是乙型肝炎复发的危险因素。结论肝移植能够有效治疗乙型肝炎相关性终末期肝病,在核苷(酸)类似物联合乙型肝炎免疫球蛋白预防后,仍有乙型肝炎复发,其对生存率的影响有待于观察。

Influencing factors of hepatitis B recurrence in patients with hepatitis B infection after orthotopic liver transplantation

Objective To investigate the risk factors and prognosis of hepatitis B recurrence in patients with hepatitis B virus （HBV）related orthotopic liver transplantation （OLT）under the prophylaxis of eombined low-dose hepatitis B immunoglobulin（HBIG）and nucleot（s）ide analogues. Methods 253 patients had OLT for HBV- related liver disease in our medical department. All patients received nucleot （s）ide analogues and low-dose HBIG therapy after liver transplantation. Results 29 patients（11.5%）died in the follow-up after liver transplantation; The fatality rates in patients with underlying hepatocellular carcinoma （HCC）and non-HCC were 21.2% （21/99）and 5.2%,respectively（P=0.000）;16 patients（6.3%）had hepatitis B recurrence;HBIG therapy in recurred patients was terminated and nucleot（s）ide analogues was modulated. All patients with hepatitis B recurrence had serum HBV DNA loss and liver function index returned to normal;Logistic regression analysis showed that risk factors for hepatitis B recurrence were HBeAg positive,high HBV DNA load,HCC and HBV/YMDD mutants Conclutions OLT is an effective treatment for the HBV correlated end-stage liver disease. Hepatitis B recurrence is not the main cause of graft loss and death under the prophylaxis of nucleoside analogues and lowdose HBIG.