Zhang D L, He X, Feng D N, Ren M J, Guang Y H, Li L X, Wang H B, Liu Z W
Liver Disease Department, The Fifth Medical Center of PLA General Hospital, Beijing 100039, China.
Zhonghua Gan Zang Bing Za Zhi. 2024 Jan 20;32(1):22-28. doi: 10.3760/cma.j.cn501113-20231127-00241.
To observe the recurrence condition of hepatitis B in different risk groups after liver transplantation in an attempt to provide useful information on whether to discontinue hepatitis B immunoglobulin (HBIG) in the future at an early stage. The patient population was divided into high, low-risk, and special groups [especially primary hepatocellular carcinoma (HCC)] according to the guidelines for the prevention and treatment of hepatitis B recurrence after liver transplantation. The recurrence condition and risk factors in this population were observed for hepatitis B. Measurement data were analyzed using a -test and a rank-sum test. Count data were compared using a (2) test between groups. This study finally included 532 hepatitis B-related liver transplant cases. A total of 35 cases had HBV recurrence after liver transplantation, including 34 cases that were HBsAg positive, one case that was HBsAg negative, and 10 cases that were hepatitis B virus (HBV) DNA positive. The overall HBV recurrence rate was 6.6%. The recurrence rate of HBV was 9.2% and 4.8% in the high- and low-risk HBV DNA positive and negative groups before surgery ( = 0.057). Among the 293 cases diagnosed with HCC before liver transplantation, 30 had hepatitis B recurrence after surgery, with a recurrence rate of 10.2%. The independent related factors for the recurrence of hepatitis B in patients with HCC after liver transplantation were HCC recurrence ( =181.92, 95% 15.992 069.96, < 0.001), a high postoperative dose of mycophenolate mofetil dispersible tablets (MMF) ( =5.190, 95% 1.28920.889, = 0.020), and a high dosage of HBIG ( = 1.012, 95% 1.001~1.023, = 0.035). Among the 239 cases who were non-HCC before liver transplantation, five cases (recurrence rate of 2.1%) arouse postoperative hepatitis B recurrence. Lamivudine was used in all cases, combined with on-demand HBIG prophylaxis after surgery. There was no hepatitis B recurrence in non-HCC patients who treated with entecavir combined with HBIG after surgery. High-barrier-to-resistance nucleotide analogues combined with long-term HBIG have a good effect on preventing the recurrence of hepatitis B after liver transplantation. The discontinuation of HBIG may be considered at an early stage after administration of a high-barrier-to-resistance nucleotide analogue in low-risk patients. Domestically, the HBV infection rate is high, so further research is still required to explore the timing of HBIG discontinuation for high-risk patients, especially those with HCC.
观察肝移植后不同风险组乙型肝炎的复发情况，试图为未来是否早期停用乙型肝炎免疫球蛋白（HBIG）提供有用信息。根据肝移植后乙型肝炎复发防治指南，将患者人群分为高、低风险和特殊组[尤其是原发性肝细胞癌（HCC）]。观察该人群中乙型肝炎的复发情况及危险因素。计量资料采用t检验和秩和检验分析。计数资料组间比较采用χ²检验。本研究最终纳入532例乙型肝炎相关肝移植病例。肝移植后共有35例发生HBV复发，其中34例HBsAg阳性，1例HBsAg阴性，10例乙型肝炎病毒（HBV）DNA阳性。总体HBV复发率为6.6%。术前HBV DNA阳性和阴性的高、低风险组HBV复发率分别为9.2%和4.8%（P = 0.057）。肝移植前诊断为HCC的293例患者中，术后有30例发生乙型肝炎复发，复发率为10.2%。肝移植后HCC患者乙型肝炎复发的独立相关因素为HCC复发（P = 181.92，95%CI 15.992069.96，P < 0.001）、术后高剂量霉酚酸酯分散片（MMF）（P = 5.190，95%CI 1.28920.889，P = 0.020）和高剂量HBIG（P = 1.012，95%CI 1.001~1.023，P = 0.035）。肝移植前非HCC的239例患者中，5例（复发率2.1%）术后发生乙型肝炎复发[所有病例均使用拉米夫定，术后按需联合HBIG预防。术后恩替卡韦联合HBIG治疗的非HCC患者无乙型肝炎复发。高耐药屏障核苷酸类似物联合长期HBIG对预防肝移植后乙型肝炎复发有良好效果。低风险患者在使用高耐药屏障核苷酸类似物后早期可考虑停用HBIG。在国内，HBV感染率高，因此仍需进一步研究探索高风险患者尤其是HCC患者停用HBIG的时机。
