肝移植术后防治乙肝复发的策略

Strategy of prevention of hepatitis B virus recurrence after liver transplantation

目的探讨乙肝标志物阳性患者行肝肝移植治疗后如何防治乙肝复发的问题。方法回顾性分析该研究院2000年10月￣2003年10月40例乙肝病毒相关终末期肝病肝移植术后,联合应用乙肝免疫球蛋白和Lamivudine对预防乙肝病毒复发的疗效。结果40例患者随访12～36个月,2例肝癌肝移植患者因肝癌复发分别于移植后8个月和13个月死亡。术后2周31例患者HBsAg、HBeAg及HBV-DNA均为阴性;6例因经济原因未能继续使用Lamivudine和HBIG的患者术后2￣9个月HBsAg阳性,并出现明显的肝功能损害,经加用Lamivudine和HBIG并护肝治疗后转阴,肝功能明显好转;3例在术后4个月内HBV-DNA、HBsAg和HBeAg阳性,4个月后HBV-DNA降至104copies/mL以下,HBsAg转阴,肝功能良好。结论乙肝病毒相关终末期肝病肝移植术后,联合应用乙肝免疫球蛋白和Lamivudine对预防乙肝病毒复发有良好的疗效。

[Objective] To investigate the prevention and treatment of hepatitis B vires （HBV） recurrence affter liver transplantation on HBV-related diseases. [Methods] Retrospective analysis the effect of 40 cases liver transplantation on HBV-related diseases performed during 2000, 10 to 2003, 10 in our hospital with combination use of HBIG and Lamivudine. [Results] 40 patients were followed tip 12-36 months. Two cases died of carcinoma recurrence at 8 month and 13 month respectively. 31 cases could not detect HBsAg, HBeAg and HBV-DNA in serum after two weeks of operation, six in which detected HBsAg positive during 2-9 month, because of cease Lamivudine and HBIG treatment for economic reason. Their liver function recovered quickly, HBsAg, HBeAg and HBV-DNA became negative after treated by Lamivudine and HBIG. Three patients＇ HBsAg, HBeAg and HBV-DNA were still positive 4 months after liver transplantation, but HBV-DNA declined below 10^4 copies/ml , HBsAg became negative and liver function kept well. [Conclusions] Combination use of Lamivudine and HBIG for prevention and treatment HBV recurrenee is well done on HBV-related diseases after liver transplantation.