Martin P, Munoz S J, Friedman L S
Department of Medicine, Jefferson Medical College, Philadelphia, Pennsylvania.
Am J Gastroenterol. 1992 Apr;87(4):409-18.
Liver transplantation is now considered definitive therapy for end-stage liver disease and has been playing an increasingly important role in the management of fulminant hepatic failure. With the advent of effective immunosuppression and improved surgical techniques, high survival rates can be expected for most transplanted patients. It has become apparent, however, that transplantation for patients with viral hepatitis is associated with some unique problems because of the propensity for viral reinfection of the grafted liver. Patients with actively replicating hepatitis B viral infection pretransplantation appear to be most likely to experience clinically significant recurrent hepatitis. Recurrent hepatitis D (delta) and hepatitis C appear to be relatively less serious in the transplanted liver. Interventions to prevent or treat graft reinfection have thus far met with limited success. Further studies are needed to define more precisely which patients with viral hepatitis are likely to do poorly after liver transplantation, and to develop strategies for treating recurrent hepatitis in transplant recipients.
肝移植目前被认为是终末期肝病的确定性治疗方法，并且在暴发性肝衰竭的治疗中发挥着越来越重要的作用。随着有效免疫抑制措施的出现和手术技术的改进，大多数接受移植的患者有望获得较高的生存率。然而，显而易见的是，由于移植肝有病毒再感染的倾向，病毒性肝炎患者的肝移植存在一些独特的问题。移植前有乙肝病毒活跃复制感染的患者似乎最有可能发生具有临床意义的复发性肝炎。复发性丁型（δ）肝炎和丙型肝炎在移植肝中似乎相对不那么严重。迄今为止，预防或治疗移植物再感染的干预措施取得的成功有限。需要进一步研究以更精确地确定哪些病毒性肝炎患者在肝移植后可能预后不良，并制定治疗移植受者复发性肝炎的策略。
