肝移植治疗淋巴瘤合并慢性乙型病毒性肝炎化疗后急性肝衰竭三例分析

Liver transplantation for acute liver failure in 3 patients with lymphoma complicated with chronic hepatitis B after chemotherapy

目的探讨肝移植治疗淋巴瘤合并慢性乙型病毒性肝炎(慢乙肝)化疗后急性肝衰竭的疗效。方法回顾性分析2009年3月至2014年7月在中山大学附属第三医院接受肝移植的3例淋巴瘤合并慢乙肝化疗后急性肝衰竭患者临床资料。所有患者均签署知情同意书,符合医学伦理学规定。3例患者术前诊断为淋巴瘤合并慢乙肝,多次化疗后出现乙型病毒性肝炎(乙肝)重新活动,导致急性肝衰竭。分析3例患者术中、术后免疫抑制方案和抗病毒治疗情况,观察术后淋巴瘤和乙肝复发情况及生存预后。结果 3例患者均急诊行肝移植治疗。患者术后早期免疫抑制方案为他克莫司(FK506)+肾上腺皮质激素(激素),术后3个月及早停用激素,改FK506单药免疫抑制治疗。术后加强抗乙型肝炎病毒治疗,抗病毒方案为恩替卡韦联合乙肝免疫球蛋白。随访至投稿日期,1例患者术后1个月余死于胆道狭窄、感染性休克;余2例恢复良好,未见淋巴瘤和乙肝复发。结论淋巴瘤合并慢乙肝化疗后急性肝衰竭患者行肝移植治疗,术后早期停用激素,加强抗病毒治疗,定期随访,可获得良好的治疗效果。

ObjectiveTo investigate the curative effect of liver transplantation (LT) for acute liver failure in patients with lymphoma complicated with chronic hepatitis B (CHB) after chemotherapy. MethodsClinical data of 3 patients with lymphoma complicated with CHB and acute liver failure after chemotherapy undergoing LT in the Third Afifliated Hospital of Sun Yat-sen University between March 2009 and July 2014 were retrospectively studied. The informed consents of all patients were obtained and the local ethical committee approval had been received. The 3 patients were diagnosed as lymphoma complicated with CHB before operation. Hepatitis B virus (HBV) reactivated after multiple chemotherapies and caused acute liver failure. The intraoperative and postoperative immunosuppressive regimens and antiviral therapy of the patients were analyzed. The recurrence of lymphoma and HBV and survival prognosis after operation were observed.ResultsThe 3 patients underwent emergency LT. The early postoperative immunosuppressive regimen was tacrolimus (FK506) + adrenocortical hormone (hormone). FK506 monotherapy was used when hormone was stopped in 3 months after LT. Anti-HBV treatment was strengthened after LT with the regimen of entecavir combined with hepatitis B immune globulin. The patients were followed up till the date of submission. One patient died of biliary stricture and septic shock 1 month after LT and the other 2 patients recovered well without recurrence of lymphoma and hepatitis B.ConclusionsPatients with lymphoma complicated with CHB and acute liver failure after chemotherapy can achieve favorable curative effect by LT, on condition that hormone is withdrawn early after operation, antivirus treatment is strengthened and regular follow-up is given.