Objective To investigate the risk factors for hepatitis B recurrence after liver transplantation for HBV-related liver disease,and to provide a basis for effective preventive measures.Methods A retrospective analysis was performed for the clinical data of 907 patients with HBV-related liver disease who underwent liver transplantation from April 2002 to December 2013.The chi-square test was used to determine the risk factors for hepatitis B recurrence,and multivariate Cox regression analysis was used for identifying the independent risk factors.Results There were 907 patients with HBV-related liver disease who underwent liver transplantation.The patients were followed up for 1-144 months,with a median follow-up time of 50.9 months.Among them,56 experienced hepatitis B recurrence,yielding a recurrence rate of 6.17％.The univariate analysis showed that positive HBeAg before surgery,positive HBV DNA before surgery,positive anti-HBc in liver donor,postoperative tumor recurrence,and postoperative regimen for the prevention of hepatitis B recurrence were significantly correlated with hepatitis B recurrence after liver transplantation (P ＜ 0.05).The multivariate Cox regression analysis showed that positive HBeAg before surgery (OR =1.891,95％ CI 1.064-3.360,P ＜ 0.05),positive anti-HBc in liver donor (OR =3.128,95％ CI 1.591-6.151,P ＜ 0.01),and postoperative tumor recurrence (OR =4.365,95％ CI 2.152-8.857,P ＜0.01) were independent risk factors for hepatitis B recurrence.Conclusion Positive HBeAg before surgery,postoperative tumor recurrence,and positive anti-HBc in liver donor are independent risk factors for hepatitis B recurrence after liver transplantation.For the patients who plan to undergo liver transplantation,antiviral therapy should be given before surgery to reduce HBV viral load,and effective preventive measures after surgery are the key to the prevention and reduction of postoperative hepatitis B recurrence.%目的 分析影响乙型肝炎相关性肝病患者肝移植术后乙型肝炎复发的危险因素,为采取有效预防措施提供依据. 方法 回顾性分析2002年4月至2013年12月907例乙型肝炎相关性肝病肝移植患者的临床资料.乙型肝炎复发的单因素分析采用x2检验,多因素分析采用COX回归分析.结果 907例乙型肝炎病毒(HBV)相关性肝病患者肝移植术后随访1～144个月,中位随访时间50.9个月,56例患者乙型肝炎复发,复发率为6.17％.单因素分析结果显示:术前HBeAg阳性、术前HBV DNA阳性、供肝抗-HBc阳性、术后肝癌(HCC)复发及术后预防乙型肝炎复发方案均与肝移植术后乙型肝炎复发明显相关(P＜ 0.05).多因素COX回归分析结果显示:术前HBeAg阳性[P＜ 0.05,OR=1.891,95％可信区间(CI):1.064 ～ 3.360]、供肝抗-HBc阳性(P＜0.01,OR=3.128,95％ CI:1.591 ～ 6.151)与术后HCC复发(P＜0.01,OR=4.365,95％ CI:2.152 ～ 8.857)均是乙型肝炎复发的独立危险因素. 结论 术前HBeAg阳性、术后HCC复发及供肝抗-HBc阳性均是肝移植术后乙型肝炎复发的独立危险因素.对于拟接受肝移植患者,术前给予抗病毒治疗,降低HBV载量,以及术后采取有效预防措施是预防和减少术后乙型肝炎复发的关键.
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