乙型肝炎相关性肝移植后乙型肝炎复发的临床特点分析

摘要

目的 总结和探讨乙型肝炎相关性终末期肝病患者在肝移植术后乙型肝炎复发的临床特点.方法 回顾性分析2005年4月至2010年4月期间的253例乙型肝炎相关性肝移植患者的术后随访资料.结果 253例肝移植患者中乙型肝炎复发16例,复发率6.32%(16/253),中位复发时间为术后13个月,术后1、3、5年的累积复发率分别为3.81%(9/236)、6.58%(15/228)、7.14%(16/224).术前HBeAg阳性、HBV DNA阳性、YMDD变异是术后乙型肝炎复发的危险因素.复发患者的主要临床表现为慢性肝炎.所有患者复发后均停用乙型肝炎人免疫球蛋白,并调整核苷(酸)类似物,经治疗HBV DNA均＜500 IU/ml,肝功能稳定.结论 肝移植能有效治疗乙型肝炎相关性终末期肝病,在核苷(酸)类似物联合乙型肝炎人免疫球蛋白方案的预防下及复发后及时处理,乙型肝炎复发对预后影响不大.%Objective To investigate the clinical characteristics of hepatitis B recurrence after hepatitis B related liver transplantation. Methods To retrospectively analysis clinical data of the 253 patients who had orthotopic liver transplantation (OLT) for hepatitis B related liver disease from Apr 2005 to Apr 2010. Results There were 16 hepatitis B recurrence in 253 OLT patients and the recurrence rate was 6. 32%(16/253). The median time of recurrence was 13 months. The first, third and fifth cumulative recurrence rate were respectively 3. 81% (9/236) , 6. 58% (15/228) and 7. 14% (16/224). The risk factors for hepatitis B recurrence includes HBeAg positive, HBV DNA positive and YMDD mutants. Chronic hepatitis is clinical manifestations of hepatitis B recurrence after OLT. Hepatitis B immunoglobulin (HBIG) was terminated and nucleoside analogues was modulated. All patients7 HBV DNA were controlled less than 500 IU/ml and liver fuction returned to normal. Conclusion OLT is an effective treatment for the hepatitis B correlated end stage liver disease. Under the prophylaxis of nucleoside analogues and HBIG, hepatitis B recurrence is not the main cause of graft loss and death if it is discovered early and change to quick and effective treatment of anti hepatitis B virus in time.