Wong P Y, McPeake J R, Portmann B, Tan K C, Naoumov N V, Williams R
Institute of Liver Studies, King's College School of Medicine and Dentistry, London, United Kingdom.
Am J Gastroenterol. 1995 Jan;90(1):29-34.
The outcome after liver transplantation for HBsAg-positive liver disease complicated by hepatocellular carcinoma is not clearly defined, and in the present study we analyzed the clinical course in 39 patients transplanted for hepatitis B virus (HBV)-related liver disease (group 1) compared with 16 patients with chronic HBV and hepatocellular carcinoma (group 2) and 52 patients with primary hepatocellular carcinoma seronegative for HBsAg (group 3).
Despite similar pretransplant viral serology, HBV recurred more often in patients with tumor (group 2) than in nontumor cases (group 1), with 1-yr actuarial cumulative reinfection rates of 85.4% versus 65.0%, respectively (p < 0.05). In group 2 cases, we observed a more aggressive pattern of HBV-related graft injury with a higher frequency of graft loss (56.3% vs. 12.8%, p < 0.001). Long-term outcome was worse in the group 2 cases, with 5-yr actuarial survival rates of 16.7% compared with 73.2% and 28.2% for groups 1 and 3, respectively. In group 2, recurrence of HBV in the graft, rather than tumor recurrence, was the principal cause of the high mortality observed (56.2% vs. 12.5%), which, in some cases, may have been potentiated by adjuvant chemotherapy.
The poor outcome of patients transplanted for HBsAg-positive cirrhosis and hepatocellular carcinoma is due to HBV reinfection of the graft, rather than tumor recurrence. Antiviral agents in association with hepatitis B immunoglobulin would be the most promising approach to improving survival in this patient population.
HBsAg阳性肝病合并肝细胞癌患者肝移植后的预后尚不明确。在本研究中，我们分析了39例因乙型肝炎病毒（HBV）相关肝病接受肝移植患者（第1组）的临床病程，并与16例慢性HBV合并肝细胞癌患者（第2组）以及52例HBsAg血清学阴性的原发性肝细胞癌患者（第3组）进行比较。
尽管移植前病毒血清学情况相似，但肿瘤患者（第2组）的HBV复发率高于无肿瘤患者（第1组），1年精算累积再感染率分别为85.4%和65.0%（p<0.05）。在第2组病例中，我们观察到HBV相关移植物损伤模式更为侵袭性，移植物丢失频率更高（56.3%对12.8%，p<0.001）。第2组病例的长期预后较差，5年精算生存率为16.7%，而第1组和第3组分别为73.2%和28.2%。在第2组中，移植物中HBV复发而非肿瘤复发是观察到的高死亡率的主要原因（56.2%对12.5%），在某些情况下，辅助化疗可能会加剧这种情况。
HBsAg阳性肝硬化和肝细胞癌患者肝移植预后不佳是由于移植物的HBV再感染，而非肿瘤复发。抗病毒药物联合乙型肝炎免疫球蛋白可能是提高该患者群体生存率最有前景的方法。
