Holt C D, Millis J M, Busuttil R W
UC San Francisco School of Pharmacy, USA.
Clin Transplant. 1995 Jun;9(3 Pt 2):269-76.
Liver transplantation is currently considered definitive therapy for end-stage liver disease (1-4). The hepatitis B virus (HBV) affects a large group of candidates for liver transplantation (1-4), however, liver transplantation for HBV is associated with unique and serious problems due to post-transplant predisposition for HBV re-infection of the allograft (5-10, 12-14). Patients with actively replicating HBV infection, as demonstrated by positive pre-transplant hepatitis surface antigen (HBsAg), hepatitis e antigen (HBeAg), and HBV-DNA, patients retransplanted for HBV infection, patients not receiving long term hepatitis B immunoglobulin (HBIG) therapy (5-10, 12, 14), and patients of Asian descent (15), appear to be most likely to experience clinically significant recurrent hepatitis (2, 3, 6-14). Recurrent HBV can produce acute or chronic liver disease leading to graft failure, retransplantation, or death (2, 3, 5, 13, 14). For these reasons, liver transplantation for HBV remains controversial. In this review, we describe the proposed mechanisms, predisposing factors, and clinical presentation associated with HBV recurrence in liver allograft recipients. We also discuss current and potential methods of prevention of HBV infection following liver transplantation.
肝移植目前被视为终末期肝病的确定性治疗方法(1 - 4)。乙肝病毒(HBV)影响着一大批肝移植候选者(1 - 4)，然而，由于移植后同种异体移植物易发生HBV再感染，HBV相关的肝移植存在独特且严重的问题(5 - 10,12 - 14)。移植前乙肝表面抗原(HBsAg)、乙肝e抗原(HBeAg)和HBV - DNA呈阳性，表明HBV感染处于活跃复制状态的患者，因HBV感染而再次接受移植的患者，未接受长期乙肝免疫球蛋白(HBIG)治疗的患者(5 - 10,12,14)，以及亚裔患者(15)，似乎最有可能发生具有临床意义的复发性肝炎(2,3,6 - 14)。复发性HBV可导致急性或慢性肝病，进而导致移植物功能衰竭、再次移植或死亡(2,3,5,13,14)。由于这些原因，HBV相关的肝移植仍然存在争议。在这篇综述中，我们描述了肝移植受者中与HBV复发相关的推测机制、易感因素和临床表现。我们还讨论了目前以及潜在的肝移植后预防HBV感染的方法。
