Yi Nam-Joon, Suh Kyung-Suk, Cho Jai Young, Kwon Choon Hyuck, Lee Kwang-Woong, Joh Jae Won, Lee Suk-Koo, Kim Soon Il, Lee Kuhn Uk
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Liver Transpl. 2007 Mar;13(3):451-8. doi: 10.1002/lt.21043.
The incidence of hepatitis B (HB) recurrence after a liver transplantation has been reduced by prophylaxis with hepatitis B immunoglobulin (HBIG) and lamivudine. However, the long-term incidence of recurrence is <10%, and the factors associated with HB recurrence are unclear. This study analyzed the factors associated with HB recurrence in 203 recipients who underwent liver transplantation for HB in 3 major centers in Korea over 4 years. Eighty-five patients (41.9%) had a hepatocellular carcinoma (HCC). Preoperative active virus replicators with the HBeAg(+) (46.8%) and/or hepatitis B virus DNA(+) (39.4%) were observed in 136 patients (67.0%). The HB prophylaxis consisted of either HBIG monotherapy (n = 95, HBIG group) or combination therapy with lamivudine (n = 108, combination group). HB recurrence was defined as the appearance of the HBsAg. The follow-up period was 28.3 +/- 13.1 months (mean +/- SD). HB recurred in 21 patients (10.3%) after transplantation. The time from transplantation to recurrence was 16.3 +/- 9.4 months. Pre-LT DNA positivity was more prevalent in HBIG group (55.8%) than in the combination group (39.8%) (P = 0.015). However, the incidence of HB recurrence was similar in the HBIG (6.3%) and combination group (13.8%), as well as between the active replicators (12.5%) and nonreplicators (4.1%) (P < 0.05). There was a far higher incidence of HB recurrence in patients receiving corticosteroid pulse therapy (21.0% vs. 7.9%), patients who experienced HCC recurrence (31.3% vs. 8.6%), and patients receiving chemotherapy to prevent HCC recurrence (25.0% vs. 4.4%) (P < 0.05). The cumulative corticosteroid dose was higher in patients who experienced recurrence of HB (P = 0.002). Multivariable analysis confirmed the effect of the cumulative corticosteroid dose and chemotherapy to be risk factors. Liver transplantation for HB is safe, with low recurrence rates if adequate prophylaxis is used. However, the cumulative corticosteroid dose and the chemotherapy used for HCC were risk factors for HB recurrence, so careful monitoring for HB recurrence is needed in these patients.
肝移植后乙肝（HB）复发的发生率已因使用乙肝免疫球蛋白（HBIG）和拉米夫定进行预防而降低。然而，复发的长期发生率<10%，且与HB复发相关的因素尚不清楚。本研究分析了韩国3个主要中心4年间203例因HB接受肝移植的受者中与HB复发相关的因素。85例患者（41.9%）患有肝细胞癌（HCC）。在136例患者（67.0%）中观察到术前有HBeAg(+)（46.8%）和/或乙肝病毒DNA(+)（39.4%）的活跃病毒复制者。HB预防措施包括单独使用HBIG治疗（n = 95，HBIG组）或与拉米夫定联合治疗（n = 108，联合组）。HB复发定义为HBsAg出现。随访期为28.3±13.1个月（均值±标准差）。移植后21例患者（10.3%）出现HB复发。从移植到复发的时间为16.3±9.4个月。移植前DNA阳性在HBIG组（55.8%）比联合组（39.8%）更常见（P = 0.015）。然而，HBIG组（6.3%）和联合组（13.8%）的HB复发发生率相似，活跃复制者（12.5%）和非复制者（4.1%）之间也是如此（P < 0.05）。接受皮质类固醇冲击治疗的患者（21.0%对7.9%）、经历HCC复发的患者（31.3%对8.6%）以及接受化疗以预防HCC复发的患者（25.0%对4.4%）中HB复发的发生率要高得多（P < 0.05）。经历HB复发的患者累积皮质类固醇剂量更高（P = 0.002）。多变量分析证实累积皮质类固醇剂量和化疗的影响是危险因素。对于HB进行肝移植是安全的，如果采用适当的预防措施，复发率较低。然而，累积皮质类固醇剂量和用于HCC的化疗是HB复发的危险因素，因此需要对这些患者仔细监测HB复发情况。
