Chen Y C, Chuang M K, Chou N K, Chi N H, Wu I H, Chen Y S, Yu H Y, Huang S C, Wang C H, Tsao C I, Ko W J, Wang S S
Department of Surgery, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan.
Transplant Proc. 2012 May;44(4):910-2. doi: 10.1016/j.transproceed.2012.03.040.
Hepatitis B virus (HBV) infection is hyperendemic in Taiwan. We have reported the outcome of (1) recipients with hepatitis B surface antigen (HBsAg)-positive; HBsAg-negative recipients who receive donor hearts from HBsAg-positive donors; and treatment with lamivudine of hepatitis B flare-ups after heart transplantation, using case numbers that range from 100 to 200.
From July 1987 to May 2011, all 412 orthotopic heart transplant recipients and donors underwent routine preoperative screening for hepatitis B virus markers and liver function parameters. Lamivudine was prescribed prophylactically for recipients with elevated serum enzyme levels or an HBV DNA virus load before transplantation, or when there was evidence of hepatitis B flare-up after transplantation. Postoperative HBV markers and liver function parameters were collected over a mean follow-up time of 7.8 years.
Thirty-four recipients were HBsAg-positive before heart transplantation, and 23 experiencing HBV reactivation upon follow-up requiring lamivudine treatment. Clinical responses were achieved in all of them: 15 were complete and two, slow partial responses. Twenty-six recipients with an HBV naïve status at the time of heart transplantation, and three patients received donor hearts from an HBsAg-positive donor under perioperative hepatitis B immunoglobulin prophylaxis. HBV infection was successfully prevented in two patients, but the other one contracted HBV hepatitis, which was successfully treated with lamivudine.
HBV reactivation after the heart transplantation was common but usually well controlled with lamivudine treatment. Although posttransplantation liver function deteriorated for a period, there was no HBV infection-related morbidity or mortality. Perioperative hepatitis B immunoglobulin prophylaxis can successfully prevent HBV naïve recipients from infection in some cases, but HBsAg-positive donors should only be considered in high risk situations.
乙型肝炎病毒（HBV）感染在台湾极为流行。我们报告了（1）乙肝表面抗原（HBsAg）阳性受者；接受来自HBsAg阳性供者心脏的HBsAg阴性受者；以及心脏移植后乙肝复发使用拉米夫定治疗的结果，病例数在100至200例之间。
1987年7月至2011年5月，所有412例原位心脏移植受者和供者均接受了术前乙肝病毒标志物和肝功能参数的常规筛查。对于移植前血清酶水平升高或HBV DNA病毒载量升高的受者，或移植后有乙肝复发证据时，预防性给予拉米夫定。术后收集HBV标志物和肝功能参数，平均随访时间为7.8年。
34例受者在心脏移植前HBsAg阳性，23例在随访中出现HBV再激活，需要拉米夫定治疗。所有患者均取得临床反应：15例完全缓解，2例部分缓解较慢。26例心脏移植时HBV初筛阴性的受者，3例患者在围手术期接受乙肝免疫球蛋白预防的情况下接受了来自HBsAg阳性供者的心脏。2例患者成功预防了HBV感染，但另1例感染了HBV肝炎，经拉米夫定治疗成功。
心脏移植后HBV再激活很常见，但通常用拉米夫定治疗可得到很好的控制。虽然移植后肝功能在一段时间内恶化，但没有与HBV感染相关的发病率或死亡率。围手术期乙肝免疫球蛋白预防在某些情况下可成功预防HBV初筛阴性受者感染，但仅在高风险情况下才应考虑使用HBsAg阳性供者。
