Abstract:

Objective To investigate the incidence and influential factors of low level of viremia（LLV） inhepatitis B related liver transplantation（LT） recipients. Methods We retrospectively analyzed the clinical data of 90 recipients who underwent liver transplantation for hepatitis B related end-stage liver disease in the Affiliated Hospital of Qingdao University，49 recipients meeting the inclusion criteria who underwent LT from December 2006 to February 2021 were enrolled. Real-time fluorescent quantitative polymerase chain reaction（RT-qPCR） was used to detect hepatitis B virus （HBV） DNA levels in these recipients. According to HBV DNA load， the recipients were divided into two groups ：LLV group（6 recipients） and complete virological response （CVR） group（43 recipients）. The incidence ofLLV and risk factors of LLV in hepatitis B LT recipients were analyzed. ResultsThere were 6 recipients in LLV group had no recurrence of hepatitis B indicated by routine detection methods， with an incidence of LLV of 12.24%. Among the6 LLV recipients，2 were given nucleoside analogues（NAs）+ hepatitis B immune globulin（HBIG）and 4 were given NAs for prevention of hepatitis B recurrence. Univariate analysis showed that high preoperative HBV DNA load， postoperative tumor recurrence， preoperative tumor stage beyond UCSF criteria and low body mass index （BMI） were the risk factors for LLV in hepatitis B LT recipients （P ＜ 0.05）. Multivariate analysis showed that high preoperative HBV DNA load was an independent risk factors for LLV in hepatitis B LT recipients. Conclusion High preoperative HBV DNAload， postoperative tumor recurrence and preoperative tumor stage beyond UCSF criteria were related to LLV in hepatitis B LT recipients. High preoperative HBV DNA load was an independent risk factors for LLV in hepatitis B LT recipients. Therefore， it is recommended to monitor LLV dynamically by highly sensitive fluorescent quantitative PCR in hepatitis B LT recipients， especially in recipients with late tumor stage and positive HBV DNA before liver transplantation. 

Key words:

 , Lower level of viremia； , Hepatitis B； , Liver transplantation； , Hepatocellular carcinoma； , Recurrence

摘要：

探讨乙型病毒性肝炎（乙肝）肝移植受者术后低病毒血症（low-level viremia， LLV） 的发生情况及其危险因素。方法 回顾性分析 90 例乙肝肝移植受者的临床资料，最终共纳入 49 例符合入选标准的受者（肝移植手术时间为 2006 年 12 月至 2021 年 2 月）。采用高灵敏实时荧光定量聚合酶链反应（real-time fluorescent quantitative polymerase chain reaction，RT-qPCR）检测乙型肝炎病毒（hepatitis B virus，HBV） DNA 水平，根据 HBV DNA 载量将患者分为 LLV 组（6 例）和完全病毒学应答组（CVR 组，43 例）。分析乙肝肝移植受者 LLV 的发生情况，比较两组受者的临床资料，以分析乙肝肝移植受者发生 LLV 的相关影响因素。结果 49 例术后常规检测方法提示没有 HBV 再感染的乙肝肝移植受者中有 6 例发生 LLV，发生率为12.24%。随访时，LLV 组 6 例受者中，有 2 例受者预防乙肝复发方案为核苷（酸）类似物（nucleosideanalogues，NAs）＋乙肝免疫球蛋白（hepatitis B immune globulin，HBIG），另外 4 例受者单用 NAs。单因素 分析结果显示，术前 HBV DNA 载量高、术后肿瘤复发、术前肿瘤分期超加州大学旧金山分校（UCSF）标准、体质量指数（body mass index，BMI）低是乙肝肝移植受者发生 LLV 的危险因素（均为 P ＜ 0.05）。多 因素分析结果显示，术前 HBV DNA 载量高是乙肝肝移植受者发生 LLV 的独立危险因素。结论 肝移植术前 HBV DNA 载量高、术前肿瘤分期超 UCSF 标准、术后肿瘤复发与乙肝肝移植受者发生 LLV 相关，其中术前 HBV DNA 载量高是乙肝肝移植受者发生 LLV 的独立危险因素。对于乙肝肝移植受者，尤其是肝移植术前肿瘤分期较晚及 HBV DNA 阳性的受者，建议采用高灵敏 RT-qPCR 动态监测 LLV。

关键词:

低病毒血症 , 乙型病毒性肝炎 , 肝移植 , 肝细胞癌 , 复发