Objective To observe the recurrence condition of hepatitis B in different risk groups after liver transplantation in an attempt to provide useful information on whether to discontinue hepatitis B immunoglobulin(HBIG)in the future at an early stage.Methods The patient population was divided into high,low-risk,and special groups[especially primary hepatocellular carcinoma(HCC)]according to the guidelines for the prevention and treatment of hepatitis B recurrence after liver transplantation.The recurrence condition and risk factors in this population were observed for hepatitis B.Measurement data were analyzed using a t-test and a rank-sum test.Count data were compared using a x2 test between groups.Results This study finally included 532 hepatitis B-related liver transplant cases.A total of 35 cases had HBV recurrence after liver transplantation,including 34 cases that were HBsAg positive,one case that was HBsAg negative,and 10 cases that were hepatitis B virus(HBV)DNA positive.The overall HBV recurrence rate was 6.6％.The recurrence rate of HBV was 9.2％and 4.8％in the high-and low-risk HBV DNA positive and negative groups before surgery(P=0.057).Among the 293 cases diagnosed with HCC before liver transplantation,30 had hepatitis B recurrence after surgery,with a recurrence rate of 10.2％.The independent related factors for the recurrence of hepatitis B in patients with HCC after liver transplantation were HCC recurrence(HR=181.92,95％CI15.99～2 069.96,P＜0.001),a high postoperative dose of mycophenolate mofetil dispersible tablets(MMF)(HR=5.190,95％CI 1.289～20.889,P=0.020),and a high dosage of HBIG(HR=1.012,95％CI 1.001～1.023,P=0.035).Among the 239 cases who were non-HCC before liver transplantation,five cases(recurrence rate of 2.1％)arouse postoperative hepatitis B recurrence.Lamivudine was used in all cases,combined with on-demand HBIG prophylaxis after surgery.There was no hepatitis B recurrence in non-HCC patients who treated with entecavir combined with HBIG after surgery.Conclusion High-barrier-to-resistance nucleotide analogues combined with long-term HBIG have a good effect on preventing the recurrence of hepatitis B after liver transplantation.The discontinuation of HBIG may be considered at an early stage after administration of a high-barrier-to-resistance nucleotide analogue in low-risk patients.Domestically,the HBV infection rate is high,so further research is still required to explore the timing of HBIG discontinuation for high-risk patients,especially those with HCC.
关键词
肝移植/乙型肝炎/肝细胞癌/乙型肝炎免疫球蛋白/复发/危险因素
Key words
Liver transplantation/Hepatitis B/Hepatocellular carcinoma/Hepatitis B immunoglobulin/Recurrence/Risk factors
维普
万方数据