肝移植后乙肝复发的预防和治疗

摘要

目的探讨原位肝移植治疗乙型肝炎相关疾病的效果及Lamivudine在防治肝移植后乙肝复发中的作用。rn方法 10例患者接受了原位肝移植，其中9例男性为乙肝患者，1例女性为肝癌患者，术前无乙肝感染。9例乙肝患者中，6例并有不同程度的肝性脑病，1例并肝肾综合征，1例并上消化道大出血。9例乙肝中，7例服用Lamivudine预防术后乙肝复发。rn结果 8例存活2-12个月，2例死亡。存活的8例中，7例为乙肝患者，仅1例术后6个月出现HBsAg(+)，但全部均肝功能良好；另1例为肝癌患者，术后6个月出现乙肝。死亡的2例中，1例为术后乙肝复发暴发性肝功能衰竭所致，另1例死于术后多器官功能衰竭。rn结论原位肝移植加Lamivudine是治疗乙肝和肝细胞癌病例的有效方法。Lamivudine在观察期内可预防乙肝移植后乙肝复发。%Objectives　To investigate the effect of orthotopic liver transplantation (OLT) on hepatitis B(HB)-related diseases and the efficiency of prevention and treatment with lamivudine on recurrence of hepatitis B posttransplant in China. rnMethods　Orthotopic liver transplantation (OLT) under veno-venous bypass was performed in 10, of whom 9 males had hepatitis B and 1 female had hepatocellular cancer (HCC) without HB pretransplant. Eight of the 9 males had fulminant hepatitis B (FHB) and they all had preoperative serious jaundice, ascites and coagulopathy. Six had encephalopathy; 1 was associaled with acute renal failure, and 1 with gastro-intestinal hemorrhage. Seven of the 10 patients had lamivudine to prevent reinfection with hepatitis B. rnResults　Of the 8 patients who have survived for 2-12 months, 7 have survived for 6-12 months. Two died, one of recurrent FHB and the other from multi-organ failure (MOF). Seven preoperative HB patients of the 8 survivors have excellent liver function though 1 has positive HBsAg 6 months after OLT. One of the 8 survivors, the female with HCC pretransplant, suffered hepatitis B 6 months after OLT and her hepatic function has been gradually improving with lamivudine therapy.rnConclusions　OLT is an effective therapy for certain cases of FHB and HCC and lamivudine may prevent recurrence of hepatitis B after OLT.