Jung Dong-Hwan, Hwang Shin, Lim Young-Suk, Kim Ki-Hun, Ahn Chul-Soo, Moon Deok-Bog, Ha Tae-Yong, Song Gi-Won, Park Gil-Chun, Lee Sung-Gyu
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Clin Transplant. 2018 Jan;32(1). doi: 10.1111/ctr.13140. Epub 2017 Dec 18.
Hepatitis A virus (HAV) can cause acute liver failure (ALF). This study compares outcomes between liver transplantation (LT) for HAV-related ALF (HAV-ALF) and LT for hepatitis B virus (HBV)-related ALF (HBV-ALF). Of 3616 adult LTs performed between January 2005 and December 2014, we performed LT for HAV-ALF recipients (n = 29) and LT for HBV-ALF recipients (n = 34). HAV-ALF group included 18 males and 11 females with mean age of 33.1 years. Graft survival rates in HAV-ALF and HBV-ALF were 65.5% and 88.0% (1 year) and 65.5% and 84.0% (5 years) (P = .048). Patient survival rates in HAV-ALF and HBV-ALF were 69.0% and 88.0% (1 year) and 69.0% and 84.0% (5 years) (P = .09). Multivariate analyses demonstrated that acute pancreatitis and HAV recurrence were independent risk factors of graft and patient survival. Post-transplant outcome was poorer in patients with HAV-ALF than in those with HBV-ALF. This weakens LT's appropriateness in HAV-ALF patients with pancreatitis. HAV recurrence after LT for HAV-ALF is common and often fatal; thus, HAV recurrence should be monitored vigilantly, beginning early post-transplant.
甲型肝炎病毒（HAV）可导致急性肝衰竭（ALF）。本研究比较了因HAV相关ALF（HAV-ALF）进行肝移植（LT）与因乙型肝炎病毒（HBV）相关ALF（HBV-ALF）进行LT的疗效。在2005年1月至2014年12月期间进行的3616例成人LT中，我们对HAV-ALF受者（n = 29）和HBV-ALF受者（n = 34）进行了LT。HAV-ALF组包括18名男性和11名女性，平均年龄33.1岁。HAV-ALF和HBV-ALF的移植物存活率分别为65.5%和88.0%（1年）以及65.5%和84.0%（5年）（P = 0.048）。HAV-ALF和HBV-ALF的患者存活率分别为69.0%和88.0%（1年）以及69.0%和84.0%（5年）（P = 0.09）。多因素分析表明，急性胰腺炎和HAV复发是移植物和患者存活的独立危险因素。HAV-ALF患者的移植后结局比HBV-ALF患者差。这削弱了LT在患有胰腺炎的HAV-ALF患者中的适用性。HAV-ALF患者LT后HAV复发很常见且往往致命；因此，应从移植后早期开始密切监测HAV复发情况。
