供、受者感染乙型肝炎病毒对造血干细胞移植的影响

The impact of hepatitis B virus infected patients or donors on the outcome of hematopoietic stem cell transplantation

目的 分析血液病患者移植前供、受者感染乙型肝炎病毒 (HBV)对造血干细胞移植(HSCT)临床结果的影响。方法 对我院 1986年 10月～ 1998年 12月间进行HSCT前供、受者感染HBV的 2 6例患者临床资料进行回顾性分析。结果 ①移植后 3例患者发生VOD ,发生率 (11.5 % )明显高于供、受者无HBV感染的患者 (1.4% ) (P <0 .0 5 ) ;② 5例输注HBsAg(+)供者造血干细胞患者 2例发生乙型肝炎 ;③ 4例异基因HSCT者发生肝功能衰竭 (LF) ,均发生在异基因移植后环孢菌素A(CsA)减量或停药过程中 ,LF的发生率 (15 .4% )明显高于供、受者未感染HBV的患者 (0 .8% ) (P <0 .0 1) ;④ 4例HBeAg(+)患者中 ,2例异基因HSCT者死于肝功能衰竭 ,而 2例自体HSCT者均生存。结论 供、受者HBV感染不是HSCT的禁忌证 ,但异基因HSCT后CsA减量或停药时有发生LF的危险 ,而HBeAg(+)的患者可能适合进行自体造血干细胞移植。

Objective To investigate the impact of recipients and/or donors infected with hepatitis B on the outcome of hematopoietic stem cells transplantation(HSCT). Methods We analyzed retrospectively the transplantation outcome in 26 of 164 hematological diseases patients who and whose donors were infected with hepatitis prior to transplantation. Results ①Three of the 26 patients developed VOD after HSCT, the incidence (11.5%) is significant higher than that in patients and donors who did not infected with HBV (P<0.05). ②Two of 5 patients transfused hematopoietic stem cells from HBsAg+ donors developed hepatitis B. ③Four patients with allogeneic stem cell transplantation developed hepatic failure(HF) which occurred during cyclosporin (CsA) being tapered off or withdrawal. The incidence of HF in patients and/or donors infected with HBV (15.4%) is obviously higher than that in patients and donors who did not (0.08%, P<0.01). ④In 4 patients with HbeAg+, 2 patients died of HF after allogeneic HSCT, the other 2 patients survived after autologous HSCT. Conclusion Donors and recipients infected with hepatitis B are not contraindication of HSCT, but patients with allogeneic HSCT are in danger to develop LF during CsA being tapered off or withdrawal.