Öcal Serkan, Korkmaz Murat, Harmancı Özgür, Ensaroğlu Fatih, Akdur Aydıncan, Selçuk Haldun, Moray Gökhan, Haberal Mehmet
From the Department of Gastroenterology and Hepatology, Başkent University, Faculty of Medicine, Ankara, Turkey.
Exp Clin Transplant. 2015 Apr;13 Suppl 1:133-8.
Hepatitis B and D virus coinfection or superinfection lead to chronic liver disease and have poor treatment results and poor prognosis. After transplant, these patients have difficult problems. We aimed to report long-term data of liver transplant recipients who had hepatitis B and D virus-related chronic liver disease.
This retrospective, longitudinal study included 25 consecutive hepatitis B surface antigen-positive patients with antihepatitis D virus antibodies. Patient data (age, sex, antiviral treatment, posttransplant use of hepatitis B hyperimmunoglobulin and/or nucleoside/nucleotide analogues, the presence of hepatocellular carcinoma, age at transplant, follow-up) were extracted from patient records.
Females comprised 32% patients. The median age was 44 years (range, 23-63 y). The serum Hepatitis B envelope antigen level was negative in all patients. At the time of transplant, 4 patients were positive for hepatitis B virus DNA and 11 patients also had hepatocellular carcinoma. Posttransplant follow-up was 59 months (range, 3-120 mo). During follow-up, 4 patients died, 4 patients were lost to follow-up, and 17 patients were alive. Posttransplant survival of patients with hepatocellular carcinoma was 50.45 months (range, 3-84 mo) and without hepatocellular carcinoma was 65.8 months (range, 4-120 mo). There were 3 patients who had acute rejection and were treated successfully with pulse doses of prednisolone. Hyperimmunoglobulin therapy was used in conjunction with oral nucleotide/nucleoside analogues for 12 months (range, 3-24 mo) and then stopped. After transplant, 4 patients had antiviral medicine changed to adefovir or entecavir because of drug resistance, and otherwise all patients remained negative for hepatitis B virus DNA during follow-up.
Patients transplanted for hepatitis B and D virus cirrhosis, even with hepatocellular carcinoma, had favorable prognosis and good longterm results. Close follow-up of patients and effective viral suppression with suitable drugs were key factors for efficient patient care.
乙型肝炎病毒与丁型肝炎病毒合并感染或重叠感染可导致慢性肝病，治疗效果不佳且预后不良。移植后，这些患者会面临棘手的问题。我们旨在报告患有乙型肝炎病毒与丁型肝炎病毒相关慢性肝病的肝移植受者的长期数据。
这项回顾性纵向研究纳入了25例连续的乙型肝炎表面抗原阳性且抗丁型肝炎病毒抗体阳性的患者。从患者记录中提取患者数据（年龄、性别、抗病毒治疗、移植后乙型肝炎高效价免疫球蛋白和/或核苷/核苷酸类似物的使用情况、肝细胞癌的存在情况、移植时年龄、随访情况）。
女性占患者总数的32%。中位年龄为44岁（范围23 - 63岁）。所有患者的血清乙型肝炎e抗原水平均为阴性。移植时，4例患者乙型肝炎病毒DNA呈阳性，11例患者同时患有肝细胞癌。移植后随访时间为59个月（范围3 - 120个月）。随访期间，4例患者死亡，4例患者失访，17例患者存活。有肝细胞癌的患者移植后生存期为50.45个月（范围3 - 84个月），无肝细胞癌的患者为65.8个月（范围4 - 120个月）。有3例患者发生急性排斥反应，经大剂量泼尼松龙成功治疗。高效价免疫球蛋白疗法与口服核苷酸/核苷类似物联合使用12个月（范围3 - 24个月）后停用。移植后，4例患者因耐药将抗病毒药物更换为阿德福韦或恩替卡韦，除此之外，所有患者在随访期间乙型肝炎病毒DNA均保持阴性。
因乙型肝炎病毒与丁型肝炎病毒肝硬化接受移植的患者，即使患有肝细胞癌，预后良好且长期效果佳。对患者进行密切随访并使用合适药物进行有效的病毒抑制是高效护理患者的关键因素。
