儿童活体肝移植受者术后新发乙型肝炎病毒感染的临床研究

摘要

目的：探讨儿童活体肝移植术后新发乙型肝炎病毒（HBV）感染的临床特点及其防治策略。方法2010年7月至2014年7月，在首都医科大学附属北京友谊医院移植中心和天津一中心医院器官移植中心接受活体肝移植术的106例儿童受者纳入本研究，所有手术由同一外科团队完成。根据供者术前 HBV 血清学标志物的结果，将儿童受者分为供肝乙型肝炎核心抗体（抗-HBc）阳性组（45例）和供肝抗-HBc 阴性组（61例）。了解两组儿童受者的新发 HBV 感染情况，分析供肝抗-HBc 阳性组儿童受者新发 HBV 感染的危险因素，了解新发 HBV 感染患儿的特征。结果供肝抗-HBc 阳性组和阴性组新发 HBV 感染发生率分别为18％（8／45）和2％（1／61）。受者术前抗-HBs 阴性、术后无抗病毒治疗是抗-HBc 阳性供肝受者新发 HBV 感染的危险因素（均为 P ＜0.05）。发病距移植手术的中位数时间12个月（8～48个月）。9例儿童受者中，接受拉米夫定治疗7例，未予抗病毒治疗2例，均全部存活。结论应用抗-HBc 阳性供肝的儿童肝移植受者，其术后存在感染 HBV 的风险。受者术前抗-HBs 阴性、术后未给予预防性核苷类似物治疗是抗-HBc 阳性供肝受者新发 HBV 感染的危险因素。接受供体抗-HBc 阳性的肝移植儿童受体应使用核苷类似物预防新发 HBV 感染，移植术前亦要加强对其接种乙肝疫苗。%Objective To investigate the clinical characteristics,prevention and treatment strategy of de novo hepatitis B virus (HBV)infection after pediatric living liver transplantation.Methods In total,106 pediatric recipients undergoing living liver transplantation in Organ Transplantation Center of Affiliated Beijing Friendship Hospital of Capital Medical University and Organ Transplantation Center of Tianjin First Center Hospital from July 2010 to July 2014 were enrolled in this study.All surgeries were performed by the same surgical team.According to preoperative test outcomes of donor HBV serological markers,all recipients were divided into the positive (n =45)and negative (n =61)antibody to hepatitis B core antigen (anti-HBc)donor liver groups (positive group and negative group),and the prevalence of de novo HBV infection was compared between two groups.The risk factors of de novo HBV infection in the positive group were analyzed to elucidate the clinical characteristics of de novo HBV infection in affected children.Results The incidences of de novo HBV infection in positive and negative group were 18% (8 /45 )and 2% (1 /61 )respectively.The risk factors of de novo HBV infection in recipients with positive anti-HBc were negative anti-HBs before transplantation and absence of antiviral therapy post-transplantation in recipients (both in P <0.05 ).The median interval between time of onset and time of liver transplantation was 12 months (8-48 months).Seven cases were treated with lamivudine and the remaining two cases were left untreated.All nine recipients survived.Conclusions Application of positive anti-HBc donor liver have a risk of HBV infection in recipients after pediatric liver transplantation.Absence of postoperative nucleoside analogue therapy and negative anti-HBs before transplantation acts as risk factors of de novo HBV infection in the recipients with positive anti-HBc donor liver.After liver transplantation,nucleoside analogue therapy is recommended for the pediatric recipients with positive anti-HBc donor liver to prevent the incidence of de novo HBV infection.Besides,hepatitis B vaccine should be administered prior to liver transplantation.