Urabe Ayako, Imamura Michio, Tsuge Masataka, Kan Hiromi, Fujino Hatsue, Fukuhara Takayuki, Masaki Keiichi, Kobayashi Tomoki, Ono Atsushi, Nakahara Takashi, Kawaoka Tomokazu, Hiramatsu Akira, Kawakami Yoshiiku, Aikata Hiroshi, Hayes Clair Nelson, Maki Noboru, Ohdan Hideaki, Chayama Kazuaki
Department of Gastroenterology and Metabolism, Applied Life Science, Institute of Biomedical and Health Science, Hiroshima University, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Advanced Life Science Institute, Inc., Wako, Japan.
J Gastroenterol. 2017 Mar;52(3):366-375. doi: 10.1007/s00535-016-1240-y. Epub 2016 Jul 15.
Post-transplant hepatitis B virus (HBV) reinfection is one of the major problems facing patients who undergo HBV-related liver transplantation (LT). We analyzed the clinical impact of serum hepatitis B core-related antigen (HBcrAg) on HBV reinfection in post-LT patients with HBV-related liver diseases.
Serum hepatitis B surface antigen (HBsAg), HBV DNA, and HBcrAg were measured over time in 32 post-LT patients. Twenty-one out of 32 patients had HCC at LT. The effects of HBcrAg, hepatocellular carcinoma (HCC) recurrence, and HBs gene mutation on HBV reinfection and withdrawal from hepatitis B immune globulin (HBIG) were analyzed.
Sixteen out of 32 patients (50 %) were positive for HBcrAg even though only six patients were thought to have experienced HBV reinfection based on reappearance of either HBV DNA or HBsAg during a median follow-up time of 75 months. Three of these six patients who became re-infected with HBV experienced HCC recurrence after LT. The HBV DNA reappearance rate was significantly higher in patients with HCC recurrence after LT (p < 0.001). Two HBV re-infected patients without HCC recurrence had HBs gene mutations G145R and G145A, respectively. Anti-HBs antibody development rate by HB vaccination was similar between HBcrAg-positive and negative patients (p = 0.325).
HBV reinfection is more common than is usually considered based on conventional measurement of HBsAg and HBV DNA. HCC recurrence and mutations in the HBV S gene were associated with HBV reinfection after LT.
移植后乙型肝炎病毒（HBV）再感染是接受HBV相关肝移植（LT）患者面临的主要问题之一。我们分析了血清乙型肝炎核心相关抗原（HBcrAg）对LT后HBV相关肝病患者HBV再感染的临床影响。
对32例LT后患者随时间检测血清乙型肝炎表面抗原（HBsAg）、HBV DNA和HBcrAg。32例患者中有21例在LT时患有肝癌。分析了HBcrAg、肝细胞癌（HCC）复发和HBs基因突变对HBV再感染及停用乙肝免疫球蛋白（HBIG）的影响。
32例患者中有16例（50%）HBcrAg呈阳性，尽管在中位随访时间75个月期间，仅6例患者因HBV DNA或HBsAg再次出现被认为经历了HBV再感染。这6例HBV再感染患者中有3例在LT后发生了HCC复发。LT后发生HCC复发的患者中HBV DNA再次出现率显著更高（p<0.001）。2例未发生HCC复发的HBV再感染患者分别有HBs基因突变G145R和G145A。HBcrAg阳性和阴性患者通过乙肝疫苗接种产生抗-HBs抗体的发生率相似（p=0.325）。
基于传统的HBsAg和HBV DNA检测，HBV再感染比通常认为的更为常见。HCC复发和HBV S基因的突变与LT后HBV再感染有关。
