Clinical management of hepatitis B virus infection correlated with liver transplantation

BACKGROUND: As a radical cure for post-hepatitis B virus (HBV)-related liver cirrhosis and hepatocellular carcinoma, liver transplantation has been applied in many medical centers. Before the use of effective measures, hepatitis B recurrence and the existence of HBsAg(+) donors, patients with hepatitis B-related diseases are contraindicated for liver transplantation. Application of interferon, hepatitis B immunoglobulin (HBIG), and nucleotide analogues (e.g., lamivudine) has made great progress in the clinical care of HBV. However, there are still many shortcomings such as low viral suppression rate, rising expense, and the induction of HBV tyrosine-methionine-aspartate-aspartate (YMDD) mutation. This article systematically reviews the current evidence that immunotherapy, conventional drug combinations, and some special fields of HBV infection correlate with liver transplantation. DATA SOURCES: Studies were identified by searching MEDLINE and PubMed for articles using the keywords 'hepatitis B virus', 'hepatitis B vaccination', 'lamivudine', 'adefovir', 'entecavir', 'tenofovir', 'HBV genotype', and 'liver transplantation' up to October 2009. Additional papers were identified by a manual search of the references from the key articles. RESULTS: Hepatitis B vaccine and human monoclonal antibody have very good clinical prospects. Compared with traditional therapies, the new medical regimens have many benefits such as boosting viral suppression rate and decreasing medical expenses. The triple therapy for YMDD mutation also has an excellent therapeutic effect and a low barrier to resistance. New nucleos(t)ide analogues (entecavir and tenofovir) eliminate virus more effectively with few adverse reactions, and may replace lamivudine or HBIG in future. CONCLUSIONS: Hepatitis B vaccine needs further large-scale and rigorous randomized controlled trials to confirm its effective dose and injection frequency. Monoclonal antibody is still experimental, and the next step is to carry out the relevant animal and human studies. A consensus standard regimen for the treatment of hepatitis B should be developed.

Review of the pharmacological management of hepatitis B viral infection before and after liver transplantation

The progress in treatment against hepatitis B virus(HBV)with the development of effective and well tolerated nucleotide analogues(NAs)has improved the outcome of patients with HBV decompensated cirrhosis and has prevented post-transplant HBV recurrence.This review summarizes updated issues related to the management of patients with HBV infection before and after liver transplantation(LT).A literature search using the PubMed/Medline databases and consensus documents was performed.Pre-transplant therapy has been initially based on lamivudine,but entecavir and tenofovir represent the currently recommended first-line NAs for the treatment of patients with HBV decompensated cirrhosis.After LT,the combination of HBV immunoglobulin(HBIG)and NA is considered as the standard of care for prophylaxis against HBV recurrence.The combination of HBIG and lamivudine is related to higher rates of HBV recurrence,compared to the HBIG and entecavir or tenofovir combination.In HBIG-free prophylactic regimens,entecavir and tenofovir should be the first-line options.The choice of treatment for HBV recurrence depends on prior prophylactic therapy,but entecavir and tenofovir seem to be the most attractive options.Finally,liver grafts from hepatitis B core antibody(anti-HBc)positive donors can be safely used in hepatitis B surface antigen negative,preferentially anti-HBc/anti-hepatitis B surface antibody positive recipients.

Prevention of hepatitis B virus reinfection after orthotopic liver transplantation

BACKGROUND: Hepatitis B virus reinfection is an impor-tant problem after liver transplantation. The aim of thisstudy was to discuss the prevention of hepatitis B virus rein-fection following orthotopic liver transplantation.METHODS: Sixty-eight cases of chronic fulminant hepatitisB, end-stage liver cirrhosis, and liver carcinoma complicat-ed with HBV cirrhosis were given anti-viral drugs beforeand after transplantation to prevent hepatitis B virus rein-fection. Lamivudine was administered in 2 patients, lami-vudine + hepatitis B immunoglobulin ( HBIG ) in 63, andadefovir + HBIG in 3. The measurement of serum HBV,HBV DNA, liver biopsy immunohistochemistry and clini-cal study were performed.RESULTS: In 1 of the 2 patients who developed reinfectionafter lamivudine administration, serum HBsAg, HBeAb,HBcAb, HBV DNA were positive and liver biopsy immu-nohistochemistry showed HBsAg phenotype. In 2 of 63 pa-tients who developed reinfection after use of lamivudine +HBIG, serum HBsAg, HBeAb, HBcAb were positive andliver biopsy immunohistochemistry showed HBsAg pheno-type. Serum HBV DNA was positive in one of them.Three patients developed no reinfection with HBV after useof adefovir.CONCLUSIONS: Orthotopic liver transplantation is effectivein the treatment of HBV-infected diseases. Lamivudine +HBIG or adefovir + HBIG could effectively prevent hepatitisB virus reinfection.

Hepatitis B and liver transplantation: Molecular and clinical features that influence recurrence and outcome

Hepatitis B virus(HBV) continues to be a major cause of morbidity and mortality worldwide. It is estimated that about 350 million people throughout the world are chronically infected with HBV. Some of these people will develop hepatic cirrhosis with decompensation and/or hepatocellular carcinoma. For such patients, liver transplantation may be the only hope for cure or real improvement in quality and quantity of life. Formerly, due to rapidity of recurrence of HBV infection after liver transplantation, usually rapidly progressive, liver transplantation was considered to be contraindicated. This changed dramatically following the demonstration that hepatitis B immune globulin(HBIG), could prevent recurrent HBV infection. HBIG has been the standard of care for the past two decades or so. Recently, with the advent of highly active inhibitors of the ribose nucleic acid polymerase of HBV(entecavir, tenofovir), there has been growing evidence that HBIG needs to be given for shorter lengths of time; indeed, it may no longer be necessary at all. In this review, we describe genetic variants of HBV and past, present, and future prophylaxis of HBV infection during and after liver transplantation. We have reviewed the extant medical literature on the subject of infection with the HBV, placing particular emphasis upon the prevention and treatment of recurrent HBV during and after liver transplantation. For the review, we searched PubMed for all papers on the subject of "hepatitis B virus AND liver transplantation". We describe some of the more clinically relevant and important genetic variations in the HBV. We also describe current practices at our medical centers, provide a summary and analysis of comparative costs for alternative strategies for prevention of recurrent HBV, and pose important still unanswered questions that are in need of answers during the next decade or two. We conclude that it is now rational and cost-effective to decrease and, perhaps, cease altogether, the routine use of HBIG during and following liver transplantation for HBV infection. Here we propose an individualized prophylaxis regimen, based on an integrated approach and risk-assessment.

HBV recurrence lowered by lamivudine/HBIG combination therapy in liver transplant patients:ten-year experience

BACKGROUND: Lamivudine and hepatitis B immunoglobulin (HBIG) are widely used to treat patients with hepatitis B recurrence after liver transplantation. However, the outcomes are inconclusive. The present study was undertaken to evaluate the effect of combined therapy on patients with hepatitis B recurrence after liver transplantation. METHODS: Twenty-two patients with hepatitis B recurrence after liver transplantation from August 2000 to October 2011 were enrolled in this study. Of these patients, 16 received lamivudine plus HBIG (combination therapy group) and 6 were treated with lamivudine alone (lamivudine-treated group) The clinical features were matched in the two groups. HBV recurrence parameters, HBsAg clearance rate, patient survival rate, and survival time were compared. RESULTS: The average time of follow-up was 47.2 months (range 13-99). Significant difference was noted in the HBsAg clearance rate in the lamivudine-treated and combination therapy groups (50% vs 93.8%, P【0.05). There was no significant difference in the time of HBV recurrence, patient survival rate and survival time between lamivudine-treated and combination therapy groups (P】0.05). CONCLUSION: Compared with lamivudine monotherapy combination therapy significantly increased the HBsAg clearance rate in patients with HBV recurrence after liver transplantation.

低剂量乙肝免疫球蛋白与拉米夫定长期联用预防肝移植后HBV复发

目的:评价长期低剂量HBIgim联用LAM预防急慢性HBV相关性终末期肝病OLT后HBV复发的效能.方法:肝移植患者173例,根据OLT后接受的抗病毒预案分成3组,LAM组(n=2)、HBIg+LAM组(n=168)和阿德福韦组(ADF,n=3).所有OLT受者术前至少接受1-2wkLAM治疗.施药剂量,LAM100mg/d,阿德福韦10mg/d.术中和术后1wk内,HBIg每日静脉给予(HBVDNA>108copies/L,总量10000U;否则总量5000U);此后imHBIg400U/次,并根据血中HBsAb滴度调整im间隔时间.1mo内维持HBsAb滴度>300U/L;3mo内HBsAb滴度>200U/L;超过3moHBsAb滴度>100U/L.定期检测肝功能、血清HBV标志物,必要时穿刺肝组织免疫组化检查.平均随访20.8±14mo.统计3种预案HBV复发的例数并分析原因;与国外同期研究结果比较.结果:4例HBV复发.LAM组1例HBV复发,术后1wkHBsAg(+),术后2moHBV(+),伴ALT升高,诊断LAM药物耐受;术后8mo死于多器官功能衰竭.HBIg+LAM组3例HBV复发,分别出现在12d,12mo和1.5mo;3例患者术前HBV-DNA>108copies/L.第1例术后血中HBeAg和HBVDNA持续(+),血中HBsAb滴度远低于有效预防浓度,诊断HBIg治疗失败,术后11mo死于爆发性肝炎.第2例成为乙肝携带者,术后15mo死于肿瘤复发.第3例HBV复发后改用HBIg+阿德福韦治疗,术后5.5moHBsAg(-),目前肝功能正常.第2和第3例可能存在HBV逃逸突变.阿德福韦组受者随访期间无HBV复发.HBIg+LAM预案,HBV相关性终末期肝病OLT后HBV复发率为1.8%(3/168);所有患者imHBIg耐受性好.OLT后HBV复发率与国外肝移植部比较,两者无统计学意义(χ2=0.28037),预防费用3000-4000＄/a.结论:长期低剂量HBIgim联用LAM可以有效预防HBV相关性终末期肝病OLT后的HBV复发,费用相对低.阿德福韦治疗HBV-YMDD变异株有效,可能是预防HBV复发的更有效因子.

单用拉米夫定及其与HBIG联用预防肝移植术后HBV复发效果比较的meta分析

[目的]综合评估比较单用拉米夫定、乙肝免疫球蛋白(HBIG)和拉米夫定联用这两种预防乙肝相关性肝病肝移植术后HBV复发方案的效果。[方法]采用meta分析方法,对检索并入选的5篇国内外比较单用拉米夫定、HBIG和拉米夫定联用这两种预防方案的临床对照试验进行综合定量分析。[结果]单用拉米夫定与HBIG和拉米夫定联用比较,病人肝移植术后1年复发率、2年复发率和乙肝病毒YMDD变异发生率均较高,合计OR值(95%CI)分别为4.91(1.8～13.30)、4.93(2.72～8.94)、3.79(1.81～7.90)。[结论]预防乙肝相关性肝移植术后乙肝复发,HBIG与拉米夫定联用方案比单用拉米夫定方案效果好。

恩替卡韦联合人免疫球蛋白预防肝移植后乙肝复发

背景:长期应用拉米夫定导致YMDD变异是肝移植后乙肝复发的主要原因。近年来恩替卡韦等新型强效低耐药抗病毒药物在乙肝相关性肝病中取得的很好的疗效,但对其在肝移植后预防乙肝复发作用的研究较为少见。目的:分析恩替卡韦联合小剂量乙型肝炎人免疫球蛋白在肝移植后预防乙型肝炎复发的作用。方法:回顾性分析253例乙型肝炎病毒相关性肝移植患者的随访资料。所有患者肝移植前即开始给予核苷(酸)类似物预防,肝移植中和移植后均给予核苷(酸)类似物联合低剂量乙型肝炎人免疫球蛋白的预防方案。在所有患者和具有乙肝复发危险因素(术前HBeAg阳性、乙型肝炎病毒DNA阳性、肝癌、YMDD变异)的患者中分别比较恩替卡韦+乙型肝炎人免疫球蛋白和拉米夫定+乙型肝炎人免疫球蛋白预防的不同效果。结果与结论:共完成253例乙型肝炎病毒相关性肝移植,死亡29例。拉米夫定组共202例,有16例复发,26例死亡,复发率为7.92%(16/202);恩替卡韦组共51例,未发现乙型肝炎病毒复发,3例死亡,两组患者复发率、死亡率差异不明显。恩替卡韦+乙型肝炎人免疫球蛋白与拉米夫定+乙型肝炎人免疫球蛋白相比,能有效降低具有乙肝复发危险因素患者的乙肝复发率。复发后均停用乙型肝炎人免疫球蛋白,并调整核苷(酸)类似物,经治疗乙型肝炎病毒DNA均<500IU/mL,肝功能稳定。Log-rank检验显示乙型肝炎病毒复发后及时治疗对患者长期存活率无明显影响。结果说明,在核苷(酸)类似物联合乙型肝炎人免疫球蛋白预防方案的预防下,乙肝复发后及时处理对预后影响不大。恩替卡韦联合乙型肝炎人免疫球蛋白能有效预防乙肝复发。对于具有危险因素的患者,恩替卡韦联合乙型肝炎人免疫球蛋白较拉米夫定联合乙型肝炎人免疫球蛋白可以更有效地降低肝移植后乙肝复发率。

联合应用拉米呋定和乙肝免疫球蛋白预防肝移植术后乙肝复发的疗效观察

目的观察联合应用拉米呋定和小剂量乙肝免疫球蛋白预防肝移植术后乙肝复发的临床疗效。方法回顾性分析35例乙肝病毒(hepatitis B virus,HBV)相关终末期肝病患者行肝移植术后联合应用拉咪夫定和小剂量乙肝免疫球蛋白的临床资料,观察此方案对预防肝移植术后乙肝病毒再感染的疗效。结果4例肝移植术后发生乙肝复发,复发率11%,其余31例病毒标志物均为阴性。结论联合应用拉米呋定和小剂量乙肝免疫球蛋白可以有效地预防乙肝病毒相关终末期肝病肝移植术后乙肝复发,小样本短期随访效果满意,有待于进一步大样本长期观察。

拉米夫定联合小剂量乙型肝炎免疫球蛋白预防肝移植术后乙型肝炎病毒复发

目的:初步探讨拉米夫定联合小剂量乙型肝炎免疫球蛋白预防肝移植术后乙型肝炎病毒(HBV)复发的疗效。方法:35例HBV相关疾病病人接受肝移植后使用拉米夫定联合小剂量乙型肝炎免疫球蛋白(HBIg)预防HBV复发,同时监测乙型肝炎血清标志物、血清HBV鄄DNA、YMDD区变异及肝活检组织乙型肝炎标记物免疫组化。结果:本组病例平均获随访557d,结果5例(14.3%)出现了HBV复发:复发病例中2例HBV鄄DNA阳性,无YMDD变异。病人术前HBeAg状态与肝移植术后HBV复发间无明显相关(P>0.05),而术前HBV鄄DNA阳性的病人术后HBV复发率显著增加(P<0.05)。结论:拉米夫啶联合小剂量HBIg预防肝移植术后HBV复发的近期疗效较为肯定。术前HBV鄄DNA状态是影响术后HBV复发的重要因素。

拉米夫定联合乙肝免疫球蛋白预防肝移植术后乙肝复发的临床分析

目的评价拉米夫定联合小剂量乙肝免疫球蛋白,在预防移植术后乙型肝炎病毒复发方面的临床效果及安全性。方法系统分析内蒙古包钢医院2004年8月～2012年9月期间,因乙肝相关终末期肝病接受肝脏移植患者34例,非随机分为两组。15例术后接受拉米夫定和个体化小剂量乙肝免疫球蛋白联合治疗,为联用组;19例接受拉米夫定单药治疗,为单药组;对全部患者的生存率及乙肝复发率进行随访。结果总体患者的中位随访时间为30个月(8-89个月),联用组为23个月(8-46个月),单药组为42个月(13-89个月)。联用组中共有2例患者出现乙肝复发,其1、3年累积乙肝复发率分别为6.67%、13.33%,单药组乙肝复发者4例,1、3年累积复发率分别为5.26%、21.05%,经比较,差异具有显著性(P<0.05)。复发病例经增大乙肝免疫球蛋白剂量或改用恩替卡韦治疗后,1例HBsAg转阴,3例HbsAg显著下降,总有效率为66.67%。而联用组与单药组中患者的1、3年生存率分别为93.33%、73.33%和89.47%、73.68%,两组间差异无显著性(P>0.05)。结论联合应用拉米夫定和小剂量乙肝免疫球蛋白可有效降低肝移植术后乙肝复发率,是预防肝移植术后乙肝复发的有效措施,值得临床推广应用。

不同用法的乙型肝炎免疫球蛋白对肝移植患者术后复发的预防作用

目的:评价乙型肝炎免疫球蛋白(HBIg)不同用法联和拉米夫定(LAM)对乙型肝炎相关性终末期肝病患者行原位肝移植术(OLT)后复发的预防作用.方法:2003-07/2008-02行同种异体肝移植患者89例,根据HBIg用法的不同分为2组:试验组43例,静点HBIg联合LAM;对照组46例,肌肉注射HBIg联合LAM.分析患者乙型肝炎患者再感染率和复发率.结果:试验组2例再感染,再感染率4.65%,1例证实有乙型肝炎复发,复发率为2.33%;对照组4例再感染,再感染率8.69%,3例证实有乙型肝炎复发,复发率为6.52%;2组中再感染及复发病例均发生在术前1wk内HBV DNA阳性的患者中,两者相比有显著统计学差异(P<0.05).结论:LAM联合静点HBIg可以有效降低HBV DNA阳性患者OLT后乙型肝炎复发率.

肝移植术后乙肝复发的预防和治疗

目的 探讨乙肝相关疾病患者肝移植术后乙型肝炎病毒 (HBV)再感染的防治。方法 复习有关文献并进行综述。结果 与HBV有关的急、慢性肝病是肝移植的主要适应证 ,但未作预防者移植后HBV再感染率可达80 %～ 10 0 % ,对移植肝的存活和患者的生存有重大的影响。如何防治肝移植后乙型肝炎的复发 ,成为急需解决的问题。经过一系列的摸索 ,目前已有许多用于防治HBV再感染的药物 ,包括抗乙肝免疫球蛋白、干扰素、核苷类似物等 ,其各自有不同的应用特点 ,在单独及联合用药方面也有了新的研究进展。结论 肝移植是治疗乙肝相关疾病的有效方法 ,围手术期的积极药物治疗 。

拉米夫定单用与联用乙肝免疫球蛋白预防肝移植术后乙肝病毒复发Meta分析

目的:应用Meta分析的方法评价拉米夫定(LAM)单用与联用乙肝免疫球蛋白(HBIg)预防肝移植术后乙肝病毒复发的疗效。方法:通过电子检索和手工检索,按照Cochrane协作网的系统评价员手册完成Meta分析。结果:共有13篇文献入选,均为病例对照研究。试验组肝移植术后乙肝病毒未复发率93.9%(766/816),对照组71.6%(140/197)。因入选文献不存在异质性,故采用固定效应模型,OR值为5.31(95% CI,3.23-8.73)。结论:HBIg与LAM合用可以有效地预防肝移植术后HBV再感染,其疗效优于单用LAM。

乙肝病毒相关肝病肝脏移植术后乙肝复发的预防和治疗

在我国施行肝移植的患者中,绝大多数是乙肝病毒相关性终末性肝病患者,术前病毒复制程度、个体免疫状态和病毒类型与移植术后易感复发密切相关。联合应用乙肝免疫球蛋白与核苷类似物可用于肝脏移植术后抗病毒治疗,近年来报道乙肝疫苗也可有效预防移植术后乙肝复发。本文重点介绍肝脏移植术后乙肝复发的机制及影响因素,探讨预防乙肝复发的各种方案的优劣。

拉米夫定联合乙型肝炎免疫球蛋白预防肝移植后乙肝病毒复发的系统评价

目的评价拉米夫定(lamivudine,LAM)联合乙型肝炎免疫球蛋白(hepatitis B immunoglobulin,HBIG)预防肝移植后乙肝病毒复发的价值。方法计算机检索MEDLINE(Ovid)、PubMed、EMbase、CENTRAL(Cochrane Central Register of Controlled Trials)、CBM、CNKI、VIP关于LAM联合HBIG与LAM单用预防肝移植后乙肝病毒复发的随机双盲对照、非随机同期对照及病例对照研究。检索时间截至2008年12月。两名研究者独立按Cochrane系统评价方法选择试验、提取资料,并采用RevMan 5.0.18软件进行Meta分析。结果共纳入11项研究,均为非随机同期对照试验,共1 421例患者,其中LAM联合HBIG组1 035例,LAM单用组386例。结果显示,LAM联合HBIG治疗组较单用LAM治疗组:①减少乙肝病毒复发风险达73%[RR=0.27,95%CI(0.20,0.37),P<0.000 01];②减少乙肝病毒YMDD变异风险达72%[RR=0.28,95%CI(0.15,0.53),P=0.000 01];③减少乙肝病毒复发所致的死亡风险达79%[RR=0.21,95%CI(0.09,0.49),P=0.000 3];④受者和移植物总的生存率两组相似[RR=1.03,95%CI(0.95,1.11),P=0.51;RR=1.04,95%CI(0.97,1.12),P=0.26]。结论现有研究显示LAM联合HBIG治疗比LAM单用可明显减少肝移植后乙肝病毒复发、发生YMDD变异及乙肝病毒复发所致的死亡风险。LAM联合HBIG是预防肝移植后乙肝病毒复发的有效措施。

阿德福韦酯联合乙肝免疫球蛋白预防HBV相关性终末期肝病肝移植术后复发的临床研究

目的:探讨阿德福韦酯(HDV)联合乙肝免疫球蛋白(HBIg)预防HBV相关性终末期肝病患者肝移植术后HBV复发的临床疗效。方法:回顾性分析2005年6月～2009年6月北京市解放军第302医院因HBV相关性终末期肝病接受肝移植的60例患者的临床资料。60例患者根据治疗方法分为治疗组和对照组,治疗组采用HDV联合HBIg预防肝移植术后HBV复发,对照组采用拉米夫定(LAM)联合HBIg预防HBV复发。结果:两组患者随访期内未出现肾毒性表现。治疗组平均随访时间为(21.67±5.37)月,随访期内无复发。对照组平均随访时间为(21.83±6.02)月,随访期内有2例复发。两组术后复发率比较有显著性差异(P<0.05)。结论:HDV联合HBIg预防肝移植术后HBV复发近期疗效优于LAM联合HBIg。

拉米夫定联合小剂量乙型肝炎免疫球蛋白预防肝移植术后乙型肝炎复发

目的比较单用拉米夫定和拉米夫定联合个体化小剂量肌肉注射乙型肝炎免疫球蛋白两种方案，预防乙型肝炎相关良性终末期肝病患者肝移植术后乙型肝炎复发的疗效。方法111例因乙型肝炎相关良性终末期肝病患者在肝移植术前根据乙型肝炎免疫球蛋白的可获得性非随机分为单用组和联用组，单用组32例患者在移植术后接受拉米夫定100mg／d单药治疗，联用组79例患者在移植术后接受拉米夫定100mg／d和个体化小剂量肌肉注射乙型肝炎免疫球蛋白（维持血清抗-HBs滴度〉100U／L）联合治疗。研究总体中位随访时间为32（1～88）个月，监测患者HBsAg、HBV DNA、抗-HBs和YMDD变异情况，随访患者生存率及乙型肝炎复发率。结果单用组共有5例患者乙型肝炎复发，其中3例发生HBV YMDD变异；肝移植术后1、2、3年累积乙型肝炎复发率分别为7．1％、14．3％、17．9％，患者生存率分别为87．5％、84．4％、74．6％。联合组共有2例患者乙型肝炎复发，且均发生YMDD变异；肝移植术后1、2、3年累积乙型肝炎复发率分别为0、1．8％、5．7％，患者生存率分别为83．5％、80．9%、77．6％。两组患者乙型肝炎复发率之间差异有统计学意义（P〈0．05），单用组肝移植术前HBVDNA活跃复制与肝移植术后乙型肝炎复发相关（P〈0．05），而联用组两者之间无相关性（P〉0．05）。结论个体化小剂量肌肉注射乙型肝炎免疫球蛋白联合拉米夫定与单用拉米夫定相比，能更有效地降低良性终末期乙型肝炎患者肝移植术后乙型肝炎复发的风险。

肝移植术后乙型肝炎病毒再感染的防治

目的 探讨肝移植治疗乙型肝炎相关肝病的效果和术后乙型肝炎病毒再感染的防治。方法 观察 17例乙型肝炎相关患者接受肝移植后 ,使用拉米夫定及乙型肝炎免疫球蛋白 (HBIg)的治疗和随访情况。结果 17例肝移植后 ,仅 2例出现HBsAg阳性 ,全部肝功能良好。结论 肝移植是治疗乙型肝炎的有效方法。拉米夫定及HBIg可有效预防肝移植术后乙型肝炎病毒的再感染。