非亲缘骨髓移植后乙肝病毒暴发性再激活的急诊活体肝移植

Emergency living related liver transplantation for fulminant reactivation of hepatitis B virus after unrelated marrow transplantation.

作者信息

Au W Y, Lau G K K, Lie A K W, Liang R, Lo C M, Fan S T, Liu C L, Hawkins B R, Ng I O L, Kwong Y L

机构信息

Departments of Medicine, Surgery and Pathology, Queen Mary Hospital, Hong Kong, China.

出版信息

Clin Transplant. 2003 Apr;17(2):121-5. doi: 10.1034/j.1399-0012.2003.00022.x.

DOI:10.1034/j.1399-0012.2003.00022.x

PMID:12709077

Abstract

We report a unique case of emergency living related donor orthotopic liver transplantation (OLT) for late fulminant reactivation of hepatitis B virus (HBV) after matched unrelated bone marrow transplantation (BMT) for chronic myeloid leukemia (CML). Cessation of lamivudine after BMT for HBV positive patients may carry risks of late fatal HBV reactivation. Similar to fulminant HBV reactivation in the general population, OLT under resumption of lamivudine can be life saving. In our case, concomitantly molecular relapse of CML at the time of liver failure was also cleared by OLT, possibly via a 'liver-graft vs. leukemia' effect. Liver rejection (graft vs. graft disease) was mild due to inherent immunocompromise of the marrow graft. Hence BMT recipients in stable remission should not be denied the opportunity for life-saving solid organ transplantation. A choice of marrow and liver donors with innate HBV immunity may be needed to give the additional advantage of long-term HBV clearance.

摘要

我们报告了一例独特的紧急活体亲属供体原位肝移植（OLT）病例，该病例是针对慢性髓性白血病（CML）患者在接受匹配的无关供体骨髓移植（BMT）后，乙肝病毒（HBV）发生晚期暴发性再激活的情况。对于HBV阳性患者，BMT后停用拉米夫定可能会带来晚期致命性HBV再激活的风险。与普通人群中暴发性HBV再激活情况类似，在重新使用拉米夫定的情况下进行OLT可能挽救生命。在我们的病例中，肝衰竭时CML的分子复发也通过OLT得以清除，可能是通过“肝移植物抗白血病”效应。由于骨髓移植物固有的免疫抑制作用，肝排斥反应（移植物抗移植物病）较轻。因此，处于稳定缓解期的BMT受者不应被剥夺接受挽救生命的实体器官移植的机会。可能需要选择具有先天性HBV免疫力的骨髓和肝脏供体，以便获得长期清除HBV的额外优势。