移植环境中的慢性乙型肝炎：意大利一家三级中心的30年经验

Chronic Hepatitis B in the Transplant Setting: A 30-Year Experience in a Single Tertiary Italian Center.

作者信息

Russo Francesco Paolo, Battistella Sara, Zanetto Alberto, Gambato Martina, Ferrarese Alberto, Germani Giacomo, Senzolo Marco, Mescoli Claudia, Piano Salvatore, D'Amico Francesco Enrico, Vitale Alessandro, Gringeri Enrico, Feltracco Paolo, Angeli Paolo, Cillo Umberto, Burra Patrizia

机构信息

Gastroenterology and Multivisceral Transplant Unit, Azienda Ospedale-Università di Padova, 35125 Padua, Italy.

Department of Surgery, Oncology and Gastroenterology, University of Padua, 35125 Padua, Italy.

出版信息

Viruses. 2025 Mar 21;17(4):454. doi: 10.3390/v17040454.

DOI:10.3390/v17040454

PMID:40284897

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12030929/

Abstract

BACKGROUND

Hepatitis B virus (HBV) remains a leading etiology for liver transplantation (LT). In a large cohort of HBsAg-positive patients, this study evaluates long-term patient and graft survival after LT over the past 30 years while analyzing trends and outcomes following waiting list (WL) inclusion over the last 15 years.

METHODS

HBsAg-positive patients who underwent transplantation between 1991 and 2020 and were waitlisted from 2006 to 2020 at Padua Hospital were included in the analysis. Patients were stratified according to hepatitis delta virus (HDV) coinfection, transplant indication (decompensated cirrhosis vs. hepatocellular carcinoma (HCC)), and WL inclusion period.

RESULTS

Among 321 HBsAg-positive LT recipients (31.5% HDV-coinfected, 46.4% HCC), 1-year and 5-year patient/graft survival rates were 87.6%/86.7% and 82.6%/82.2%, respectively. From 2006 to 2020, 284 HBsAg-positive patients were waitlisted (32.6% HDV-coinfected), with a significantly higher prevalence of HCC compared to non-HBV patients ( = 0.008). High-barrier nucleos(t)ide analogues (hbNUCs) significantly reduced mortality ( = 0.041) and improved survival post-WL inclusion ( = 0.007). Survival rates were consistent regardless of LT indication, HDV coinfection, or WL inclusion period. Post-transplant prophylaxis predominantly involved immunoglobulins (HBIG) + NUCs, resulting in only two cases of HBV reactivation, both clinically inconsequential.

CONCLUSIONS

Over the past 30 years, HBV has remained a consistent indication for LT at our center. Thanks to hbNUCs, WL outcomes have improved and HCC has become the main indication for LT.

摘要

背景

乙型肝炎病毒（HBV）仍然是肝移植（LT）的主要病因。在一大群HBsAg阳性患者中，本研究评估了过去30年LT后的长期患者和移植物存活率，同时分析了过去15年列入等待名单（WL）后的趋势和结果。

方法

分析纳入1991年至2020年间在帕多瓦医院接受移植且于2006年至2020年列入等待名单的HBsAg阳性患者。根据丁型肝炎病毒（HDV）合并感染、移植指征（失代偿性肝硬化与肝细胞癌（HCC））以及列入WL的时间段对患者进行分层。

结果

在321例HBsAg阳性LT受者中（31.5%为HDV合并感染，46.4%为HCC），1年和5年的患者/移植物存活率分别为87.6%/86.7%和82.6%/82.2%。2006年至2020年，284例HBsAg阳性患者被列入等待名单（32.6%为HDV合并感染），与非HBV患者相比，HCC的患病率显著更高（P = 0.008）。高耐药性核苷（酸）类似物（hbNUCs）显著降低了死亡率（P = 0.041），并改善了列入WL后的存活率（P = 0.007）。无论LT指征、HDV合并感染或列入WL的时间段如何，存活率均保持一致。移植后预防主要采用免疫球蛋白（HBIG）+核苷（酸）类似物，仅导致2例HBV再激活，两者在临床上均无显著影响。