König V, Hopf U, Neuhaus P, Bauditz J, Schmidt C A, Blumhardt G, Bechstein W O, Neuhaus R, Lobeck H
Department of Internal Medicine, Universitätsklinikum Rudolf Virchow, Freie Universität Berlin, Germany.
Transplantation. 1994 Sep 15;58(5):553-9. doi: 10.1097/00007890-199409150-00005.
The outcome after OLT was studied in 53 patients with chronic hepatitis B virus (HBV)* infection, 15 of whom had, in addition, evidence of hepatitis delta virus (HDV) superinfection. Nine of 53 patients received short-term immunoprophylaxis with anti-hepatitis B surface (HBs) hyperimmunoglobulin up to 1 week after OLT and 44 of 53 patients received long-term unlimited immunoprophylaxis. Eight of 9 (89%) patients with short-term immunoprophylaxis showed reactivation of replication with HBV DNA in serum > 10 pg/ml independently of the preoperative HBV DNA level and HBsAg reappeared in all cases. Four (44%) patients in this group lost their graft because of fulminant hepatitis or cirrhosis and required retransplantation, and 2 patients (22%) died after reinfection in the second graft. Nineteen of 44 (43%) patients with long-term immunoprophylaxis developed HBV values > 10 pg/ml after transplant and 12 of 44 (27%) became HBsAg+ again. Most of them had quantifiable HBV DNA levels before OLT. Retransplantation was required in 5 of 44 (11%) patients and 4 of them died after HBV recurrence. The frequency of HBV reactivation and the development of viral hepatitis after OLT were associated with the preoperative presence of HBV, as determined by the molecular hybridization assay. With nested polymerase chain reaction, all 53 patients were HBV-DNA+ in the serum before and after OLT. with just one exception, none of the patients with HDV superinfection died, in spite of increased HDV replication after OLT. The data indicate that long-term immunoprophylaxis with anti-HBs hyperimmunoglobulin after OLT improves the prognosis in HBV-infected patients. The preoperative detection of HBV DNA in serum by molecular hybridization assay is correlated with graft infection and represents a prognostic parameter. The presence of HDV may have a protective effect after OLT.
对53例慢性乙型肝炎病毒（HBV）感染患者进行了肝移植（OLT）后的预后研究，其中15例还存在丁型肝炎病毒（HDV）重叠感染的证据。53例患者中有9例在OLT后接受了为期1周的抗乙型肝炎表面（HBs）高效价免疫球蛋白短期免疫预防，53例患者中有44例接受了长期无限制免疫预防。9例接受短期免疫预防的患者中有8例（89%）血清中HBV DNA复制重新激活，血清HBV DNA>10 pg/ml，与术前HBV DNA水平无关，且所有病例均再次出现HBsAg。该组中有4例（44%）患者因暴发性肝炎或肝硬化失去移植物，需要再次移植，2例（22%）患者在第二次移植后再次感染后死亡。44例接受长期免疫预防的患者中有19例（43%）在移植后HBV值>10 pg/ml，44例中有12例（27%）再次变为HBsAg阳性。他们中的大多数在OLT前HBV DNA水平可检测到。44例患者中有5例（11%）需要再次移植，其中4例在HBV复发后死亡。OLT后HBV重新激活的频率和病毒性肝炎的发生与术前分子杂交检测确定的HBV存在有关。采用巢式聚合酶链反应，53例患者在OLT前后血清中均为HBV-DNA阳性。仅有1例例外，尽管OLT后HDV复制增加，但HDV重叠感染的患者无一死亡。数据表明，OLT后用抗HBs高效价免疫球蛋白进行长期免疫预防可改善HBV感染患者的预后。通过分子杂交检测血清中术前HBV DNA与移植物感染相关，是一个预后参数。HDV的存在可能在OLT后具有保护作用。
