McCaughan G W
AW Morrow Gastroenterology and Liver Centre, and Australian National Liver Transplant Unit, Royal Prince Alfred Hospital and University of Sydney, Camperdown, New South Wales.
J Gastroenterol Hepatol. 2000 May;15 Suppl:E172-4.
The general indications for liver transplantation in hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, and the issues surrounding treatment for HBV infection in the pre- and post-transplant periods, are discussed. In general, transplantation is reserved for patients with end-stage liver failure secondary to cirrhosis and a small population with acute liver failure. It is proposed that certain guidelines can be developed and that these should include any one of the following: a Child-Pugh score > or = 9, diuretic resistant ascites, recurrent portal hypertensive bleeding, recurrent encephalopathy, spontaneous bacterial peritonitis and the development of a small hepatocellular cancer (< or = 5 cm in diameter). Treatment for HBV infection now includes lamivudine therapy pre and post transplantation together with hepatitis B immunoglobulin. Such an approach has virtually abolished recurrence of HBV infection following liver transplantation.
本文讨论了乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）感染患者肝移植的一般指征，以及移植前后HBV感染的治疗相关问题。一般而言，肝移植适用于因肝硬化导致终末期肝衰竭的患者以及一小部分急性肝衰竭患者。建议制定某些指导原则，这些原则应包括以下任何一项：Child-Pugh评分≥9分、利尿剂抵抗性腹水、反复门静脉高压出血、反复肝性脑病、自发性细菌性腹膜炎以及小肝细胞癌（直径≤5cm）的发生。目前，HBV感染的治疗包括移植前后使用拉米夫定治疗以及乙型肝炎免疫球蛋白。这种方法几乎消除了肝移植后HBV感染的复发。
