肝移植术后乙型肝炎病毒再感染的预防

Prevention of Hepatitis B Virus Reinfection after Liver Transplantation

目的探讨肝移植术后乙型肝炎病毒再感染的预防。方法回顾性分析88例乙型肝炎病毒(HBV)相关终末期肝病,分别为慢性乙型重症肝炎、终末期肝硬化及合并肝癌患者,行肝移植术后联合应用拉米夫定、抗乙型肝炎免疫球蛋白(HBIg)的临床资料,术前均服用拉米夫定,术后3例患者单用拉米夫定,85例联合应用拉米夫定及小剂量抗HBIg,以临床血液病毒学、肝活检免疫组化及临床症状变化为指标,随访≥6个月。结果单用拉米夫定组3例中有2例术后HBV再感染,最短时间为术后6个月;联合应用拉米夫定及小剂量HBIg组,85例患者仅3例再感染。结论肝脏移植是治疗HBV感染相关终末期肝病的有效手段,术前服用拉米夫定降低HBV的复制水平,术后联合应用拉米夫定及小剂量HBIg可更有效防治HBV感染相关性肝病行肝移植术后乙型肝炎病毒再感染。

OBJECTIVE To discuss the preventive methods of hepatitis B virus reinfection after liver transplantation. METHODS Eighty eight liver transplantation recipients with HBV-related end-stage liver diseases including chronic fulminant hepatitis B, end-stage liver cirrhosis and liver carcinoma were analyzed retrospectively, and were given lamivudine pre-transplantation to prevent hepatitis B virus reinfection. Post-transplantation medicines of lamivudine were administered in 3 cases; lamivudine and hepatitis B immunoglobulin （HBIg） in 85 cases. The follow-up criteria included serum HBV, HBV-DNA, liver biopsy, immunohistochemical study of liver biopsy specimens and clinical manifestations. All of patients were followed-up 6 months at least. RESULTS Two of the three cases who taken lamivudine developed reinfection, the little time is 6 months following liver transplantation. There were three of eighty five cases taken lamicudine and HBIg （small dosage） developed reinfection. CONCLUSIONS Liver transplantation is an effective treatment for HBV-related end-stage liver diseases. Given lamivudine at the pre-transplantation could reduce the levels of the HBV virus copies. Lamivudine and HBIg post-transplantation offer effective prevention against hepatitis B virus reinfection.