Practical Journal of Organ Transplantation(Electronic Version) ›› 2021, Vol. 9 ›› Issue (1): 31-36.DOI: 10.3969/j.issn.2095-5332.2021.01.008

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Risk factors of hepatitis B virus infection after liver transplantation related to the recipients

Jia Yanan,Li Han,Lu Shaocheng,Zhu Jiqiao,Xu Wenli,Li Xianliang,He Qiang.   

  1. Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital,Beijing,100000,China
  • Online:2021-01-20 Published:2021-06-01

受体相关肝移植术后乙肝复发的危险因素分析

贾亚男,李瀚,吕少诚,朱继巧,许文犁,李先亮,贺强
  

  1. 首都医科大学附属北京朝阳医院肝 胆胰脾外科,北京 100020
  • 基金资助:
    国家自然科学基金(81571554,81273270,81471590)

Abstract:

Objective The aim of this study was to determine the risk factors associated with the recurrenceof hepatitis B virus infection after liver transplantation related to the recipients. Methods Clinical data of 320 consecutive patients who had history of Hepatitis B and underwent liver transplantation in Beijing Chaoyang Hospital from 2013 to 2019 were retrospectively collected,followed and analyzed. The data which are probableinformation related to the recurrence of hepatitis B in the perioperative period were organized and analyzed. ResultsAmong the 320 patients, 178 patients had hepatic malignant tumor caused by hepatitis B,84 patients experienced liver failure caused by hepatitis B and 58 patients had decompensated liver cirrhosis. Recurrence of hepatitis B was diagnosed in 25 patients at the end of the follow-up date with an incidence rate of 7.8%. The mean duration of recurrence was 19.7 months. The 1-,3- and 5-year recurrence rate after surgery were 3.0%,10.5% and 11.5%. The 1-,3- and 5-year recurrence rate of hepatitis B of patients with benign liver disease and patients withhepatic malignant tumor were 0%,3.9%,3.9% and 5.5%,16.6%,18.6%(P = 0.001)respectively. Multivariate analysis showed that the causes of primary disease(RR = 3.639,95%CI :1.138 ~ 11.637),replications amountof HBV DNA(RR = 2.180,95%CI :1.362 ~ 3.489)and the history of hepatitis B treatment(RR = 6.011,95%CI :1.769 ~ 20.421)were the independent risk factors which affect the recurrence of hepatitis B after livertransplantation. Conclusion The primary disease,the activity level of hepatitis B replication and the antiviral treatment before surgery are associated with the recurrence of hepatitis B after liver transplantation. The recipients with malignant liver tumor,higher HBV DNA replication and without any antiviral treatment had a higher risk of hepatitis B recurrence after liver transplantation. 

Key words: Liver transplantation, Viral hepatitis B, Recurrence, Risk factors

摘要:

目的 本研究旨在探讨影响受体相关肝移植术后乙肝复发的危险因素。方法 回顾性搜集、随访、分析北京朝阳医院 2013 — 2019 年 7 年中连续 320 例有乙肝病史并行肝移植手术治疗的患者的临床资料,搜集可能与乙肝复发有关的围术期参数,并对可能影响患者术后乙肝复发的危险因素进行分析。结果在 320 例患者中,原发疾病为乙肝所致肝恶性肿瘤患者 178 例,乙肝所致肝功能衰竭患者 84 例,乙肝肝硬化失代偿期患者 58 例。截止随访日期,共有 25 例患者发生乙肝复发,总体复发率为 7.8%。患者的平均复发时间为 19.7 个月,术后 1、3、5 年乙肝复发率分别为 3.0%、10.5%、11.5%。良性疾病和恶性肿瘤患者的1、3、5 年乙肝复发率分别为 0%、3.9%、3.9% 和 5.5%、16.6%、18.6%(P = 0.001)。多因素分析显示,受体病因(RR = 3.639,95%CI :1.138 ~ 11.637)、乙肝 DNA 复制量(RR = 2.180,95%CI :1.362 ~ 3.489)和乙肝治疗史(RR = 6.011,95%CI :1.769 ~ 20.421)是影响移植术后乙肝复发的独立危险因素。结论 肝移植术后乙肝复发与其原发疾病、病毒复制活跃程度及术前抗病毒治疗有关,原发病为肝恶性肿瘤、乙肝DNA 复制量高和既往未治疗乙肝的肝移植受体,术后乙肝复发的风险较高。

关键词: 肝移植 , 乙型病毒性肝炎 , 复发 , 危险因素