儿童肝移植术后乙型肝炎防治的进展

Recent advances in the prevention and treatment for hepatitis B after liver transplantation in children

肝移植作为治疗终末期肝病的有效手段广泛应用于我国儿童终末期肝病的治疗中。目前,我国成年人群体中乙型肝炎病毒(hepatitis B virus,HBV)感染率明显高于西方国家,这使得部分患儿进行肝移植手术时需要接受来自乙型肝炎核心抗体阳性供者的肝脏。虽然已经有国内外的研究证明,HBV血清反应阴性的患者通过肝移植围手术期及术后进行主动免疫,术中及术后使用乙型肝炎免疫球蛋白,术后预防性使用核苷类似物等手段可以明显降低肝移植术后新发HBV感染率,但对于儿童肝移植还没有统一的指导意见。本文总结近几年国内外关于儿童肝移植围手术期及术后远期对新发HBV感染的预防和治疗的研究进展,并对其临床应用提供建议。

Liver transplantation(LT)is effective and widely applied for end-stage liver disease in children in China.Currently the infection rate of hepatitis B virus in adults is significantly higher in our country than that in Western countries.This makes it inevitable for some children to receive livers from hepatitis B core antibody positive donors for LT.Although many studies have demonstrated that the risks of de novo HBV infection for patients seronegative for hepatitis B virus could be significantly lowered by active perioperative immunization,receiving hepatitis B immunoglobulin during and after surgery and taking nucleoside analogues after surgery.Yet no widely accepted guideline is available for pediatric LT.This review summarized recent advances of preventing and treating HBV infection in LT children during peri-operation and long-term post-operation.