Ma Yi, Tai Qiang, He Xiao-shun, Wang Guo-dong, Hu An-bin
Department of Transplantation Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
Zhonghua Wai Ke Za Zhi. 2009 Aug 15;47(16):1209-12.
To investigate the prevention and treatment of hepatitis B virus (HBV) reinfection and recurrence after orthotopic liver transplantation (OLT) for HBV related end-stage liver disease.
The clinical data of 316 patients undergoing allograft orthotopic liver transplantation who lived more than 6 months and had HBV infection preoperative with complete data from March 2001 to March 2007 at the First Affiliated Hospital of Sun Yat-sen University. According to the HBV prevention strategy, these patients were divided into two groups: group with pure lamivudine (LAM) (n = 106) and group with lamivudine plus intramuscular injection of low dose anti-hepatis B immunoglobulin (HBIG) (n = 210).
Mean follow-up was 33.6 months. The rate of HBsAg negative conversion 1 week after OLT of the LAM group was 82.1% (87/106), significantly lower than that of LAM + HBIG group [91.0% (191/210), P < 0.05]. The rates of HBV reinfection, HBV recurrence, and YMDD mutation of the lamivudine group was 17.0% (18/106), 11.3% (12/106) and 8.5% (9/106) respectively, all significantly higher than those of LAM + HBIG group [6.2% (13/210), 3.8% (8/210) and 2.4% (5/210) respectively, P < 0.05 respectively]. All patients with HBV reinfection or HBV recurrence were treated with Adefovir, Entecavir or increased dose of HBIG and achieved better curative effect.
The therapy with high dose of HBIG combining with adefovir or entecavir is better for patients who have HBV reinfection. Patients with HBV recurrence after OLT should be administrated reasonable liver aid, immunity regulation and anti-hepatic fibrosis to obtain better transplant liver histological results and normal transplant liver function.
探讨乙型肝炎病毒（HBV）相关终末期肝病患者原位肝移植（OLT）后HBV再感染及复发的防治措施。
回顾性分析2001年3月至2007年3月在中山大学附属第一医院行同种异体原位肝移植且术后存活6个月以上、术前有HBV感染且资料完整的316例患者的临床资料。根据HBV防治策略，将患者分为两组：单纯拉米夫定（LAM）组（n = 106）和拉米夫定联合小剂量乙型肝炎免疫球蛋白（HBIG）肌肉注射组（n = 210）。
平均随访33.6个月。LAM组OLT术后1周HBsAg转阴率为82.1%（87/106），显著低于LAM + HBIG组[91.0%（191/210），P < 0.05]。拉米夫定组HBV再感染率、HBV复发率及YMDD变异率分别为17.0%（18/106）、11.3%（12/106）和8.5%（9/106），均显著高于LAM + HBIG组[分别为6.2%（13/210）、3.8%（8/210）和2.4%（5/210），P均< 0.05]。所有HBV再感染或HBV复发患者经阿德福韦、恩替卡韦治疗或增加HBIG剂量后，疗效较好。
高剂量HBIG联合阿德福韦或恩替卡韦治疗对HBV再感染患者疗效更佳。OLT术后HBV复发患者应给予合理的保肝、免疫调节及抗肝纤维化治疗，以获得较好的移植肝组织学结果及正常的移植肝功能。
