Marsman W A, Wiesner R H, Batts K P, Poterucha J J, Porayko M K, Niesters H G, Zondervan P E, Krom R A
Division of Liver Transplantation, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Hepatology. 1997 Feb;25(2):434-8. doi: 10.1002/hep.510250230.
Liver transplantation for hepatitis B virus (HBV)-related liver disease is complicated by HBV recurrence and, consequently, poor patient and graft survival. Patients transplanted for hepatitis delta virus (HDV)-related cirrhosis are reported to have a diminished incidence of HBV recurrence and improved graft survival. However, only a few reported HDV-infected patients had active HBV replicative disease before liver transplantation. In our experience, we transplanted two HDV-infected patients, both of whom had active HBV replication before liver transplantation. In one patient, hepatitis B surface antigen (HBsAg) recurred four months after transplantation. Two months later, Hepatitis Be antigen (HBeAg) and HBV-DNA became positive, and the patient died of fulminant recurrent hepatitis B and hepatitis delta. In the other patient, HBV persisted after transplantation, and 2 months later the patient required retransplantation for fulminant recurrent hepatitis B and hepatitis delta. With the second graft, the patient remained free of HBV infection for 1 year. Thereafter, the patient experienced HBV recurrence with active replication and died of fulminant hepatitis B and delta recurrence. In the first case and in the second graft of the second case, hepatitis B immunoglobulin (HBIG) immunoprophylaxis was administered in an attempt to prevent recurrence of HBV. The literature suggests that an HDV infection inhibits the replication of HBV and therefore plays a role in preventing the recurrence of HBV and improving survival. Our experience with two patients suggests that HDV infection, in the presence of active HBV replication, may not play a protective role.
乙型肝炎病毒（HBV）相关肝病的肝移植因HBV复发而变得复杂，进而导致患者和移植物存活率较低。据报道，因丁型肝炎病毒（HDV）相关肝硬化接受移植的患者HBV复发率降低，移植物存活率提高。然而，仅有少数报道的HDV感染患者在肝移植前存在活跃的HBV复制性疾病。根据我们的经验，我们为两名HDV感染患者进行了移植，这两名患者在肝移植前均有活跃的HBV复制。其中一名患者在移植后四个月出现乙型肝炎表面抗原（HBsAg）复发。两个月后，乙型肝炎e抗原（HBeAg）和HBV-DNA呈阳性，该患者死于暴发性复发性乙型肝炎和丁型肝炎。另一名患者移植后HBV持续存在，两个月后因暴发性复发性乙型肝炎和丁型肝炎需要再次移植。第二次移植后，该患者1年内未出现HBV感染。此后，该患者出现HBV复发并伴有活跃复制，死于暴发性乙型肝炎和丁型肝炎复发。在第一个病例以及第二个病例的第二次移植中，均给予了乙型肝炎免疫球蛋白（HBIG）免疫预防，以试图预防HBV复发。文献表明，HDV感染可抑制HBV复制，因此在预防HBV复发和提高生存率方面发挥作用。我们对两名患者的经验表明，在存在活跃HBV复制的情况下，HDV感染可能不发挥保护作用。
