Samuel D, Bismuth A, Mathieu D, Arulnaden J L, Reynes M, Benhamou J P, Brechot C, Bismuth H
Hepatobiliary Surgery and Liver Transplantation Research Unit, Paris South University, France.
Lancet. 1991 Apr 6;337(8745):813-5. doi: 10.1016/0140-6736(91)92515-4.
110 HBsAg-positive patients underwent orthotopic liver transplantation and received long-term anti-hepatitis B virus (HBV) passive immunoprophylaxis with anti-HBs immunoglobulin. During a mean follow-up period of 20 months, all patients became HBsAg negative after transplantation but circulating HBsAg reappeared in 25 (22.7%). Overall 1-year survival was 83.6% and overall 2 year actuarial recurrence of HBsAg was 29% (59% after posthepatitis B cirrhosis, 13% after posthepatitis B-delta cirrhosis, and 0% after fulminant hepatitis B). Patients with HBV cirrhosis who were HBV-DNA positive had a much greater risk of HBsAg recurrence than patients who were HBV-DNA negative (96% vs 29% at 2 years). Reappearance of HBsAg was associated with evidence of HBV replication and abnormal histological findings in the graft. Long-term passive anti-HBV immunoprophylaxis significantly reduced HBV reinfection and improved survival in patients without evidence of active HBV replication before orthotopic liver transplantation.
110例乙肝表面抗原（HBsAg）阳性患者接受了原位肝移植，并接受了抗-HBs免疫球蛋白进行长期抗乙型肝炎病毒（HBV）被动免疫预防。在平均20个月的随访期内，所有患者移植后均变为HBsAg阴性，但25例（22.7%）患者循环中的HBsAg再次出现。总体1年生存率为83.6%，HBsAg的总体2年精算复发率为29%（乙型肝炎后肝硬化后为59%，乙型肝炎-丁型肝炎后肝硬化后为13%，暴发性乙型肝炎后为0%）。HBV-DNA阳性的HBV肝硬化患者HBsAg复发风险比HBV-DNA阴性患者高得多（2年时分别为96%和29%）。HBsAg的再次出现与HBV复制证据及移植肝组织学异常有关。长期被动抗HBV免疫预防显著降低了原位肝移植前无活动性HBV复制证据患者的HBV再感染并提高了生存率。
