Gastrohepatology Unit, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
Liver Transplant Center and General Surgery 2U, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
Transplantation. 2022 Oct 1;106(10):1935-1939. doi: 10.1097/TP.0000000000004138. Epub 2022 Apr 11.
Hepatitis D is caused by the hepatitis D virus (HDV); it is the most severe form of viral hepatitis in humans, running an accelerated course to cirrhosis. There is no efficacious therapy, and liver transplantation provides the only therapeutic option for terminal HDV disease. However, HDV infection is prevalent in poor countries of the world with no access to liver transplant programs; liver grafting has been performed in high-income countries, where the prevalence of the infection has much diminished as a secondary effect of hepatitis B virus vaccination, and the demand for liver transplantation outlives in aging cirrhotics who acquired hepatitis D decades ago. This review describes the evolution of liver transplantation for HDV disease from its inception in 1987 to the present time, with an outlook to its future. It reports the progress in the prophylaxis of HDV reinfections to the success of the current standard of indefinite combination of hepatitis B virus antivirals with immunoglobulins against the hepatitis B surface antigen; however, the unique biology of the virus provides a rationale to reducing costs by limiting the administration of the immunoglobulins against the hepatitis B surface antigen.
丁型肝炎由丁型肝炎病毒（HDV）引起；它是人类最严重的病毒性肝炎，呈加速性向肝硬化发展。目前尚无有效的治疗方法，肝移植是丁型肝炎终末期疾病的唯一治疗选择。然而，丁型肝炎感染在世界上许多无法获得肝移植项目的贫困国家很普遍；肝移植已在高收入国家进行，由于乙型肝炎病毒疫苗接种的次要作用，感染的流行率大大降低，而且由于几十年前感染乙型肝炎病毒的老年肝硬化患者的需求，肝移植的需求超过了老龄化的肝硬化患者。这篇综述描述了从 1987 年开始至今肝移植治疗丁型肝炎的发展历程，并展望了其未来。它报告了丁型肝炎再感染预防的进展，目前标准的乙型肝炎病毒抗病毒药物联合乙型肝炎表面抗原免疫球蛋白的治疗取得了成功；然而，病毒的独特生物学为通过限制乙型肝炎表面抗原免疫球蛋白的使用来降低成本提供了依据。
