Abstract:

Objective To compare the clinical effects of different regimens for prophylaxis of hepatitis B recurrence post liver transplantation in different times of a single center，summarize and optimize the treatment protocol. Methods Nine hundred and eighty-four adult patients diagnosed as hepatitis B related end stage benignliver diseases underwent primary liver transplant between May 1994 and December 2012，of whom 62 recipients died within 30 days after transplantation and were not included for statistical analysis. The remaining 922 patients were grouped as non-treatment，famciclovir，lamivudine and nucleos（t）ide analogues combined with hepatitis Bimmune globulin（HBIG）group based on 4 different regimens for prophylaxis of hepatitis B recurrence post liver transplantation. Results Hepatitis B recurrence occurred in 27 patients. Among them，all the 3 patients of non-treatment group（underwent transplant between 1994-1999）showed recurrence，all the 2 patients in famciclovir group （underwent transplant between 1998-1999）showed recurrence，6 patients（40.0%）in lamivudine group（underwenttransplant between 1998-2001）showed recurrence，and 16 patients（1.8%）in nucleos（t）ide analogues combined with HBIG group（underwent transplant between 1999-2012）showed recurrence. Both cumulative hepatitis B recurrence rates（χ2 ＝ 48.99，P ＝ 0.000）and cumulative patient survival rates（χ2 ＝ 62.694，P ＝ 0.000）showed significant statistical significance among these four groups of patients. Conclusion With the successful development and widespread marketing of nucleos（t）ide analogues and HBIG，regimens for prophylaxis of hepatitis B recurrence after liver transplantation have been optimized gradually in our center. Nucleos（t）ide analogues combinedwith HBIG was proved effective，and has been applicated by many other centers throughout our whole country，which provides strong support for the outcomes of liver transplantation in HBV-related end stage liver diseases.

摘要：

目的 比较单中心不同年代预防肝移植术后乙型肝炎（乙肝）复发治疗方案的临床效果，总结、优化治疗方案。方法 选择天津市第一中心医院器官移植中心 1994 年 5 月至 2012 年 12 月因乙肝相关良性肝病接受首次肝移植术的 984 例成年患者，剔除围手术期（术后 30 天内）死亡者 62 例。依据患者术后预防乙肝复发治疗方案分为未治疗组、泛昔洛韦组、拉米夫定组和核苷（酸）类似物 + 乙肝免疫球蛋白（HBIG）组。结果 922 例患者中共有 27 例肝移植术后出现乙肝复发，其中 3 例肝移植术后未接受任何预防乙肝复发治疗的患者，均出现了乙肝复发，手术日期为 1994 ～ 1999 年间 ；术后接受泛昔洛韦治疗组患者 2 例，均出现乙肝复发，手术日期为 1998 至 1999 年间 ；单一应用拉米夫定组患者共 15 例，其中 6 例出现乙肝复发（40.0%），手术日期为 1998 至 2001 年间 ；1999 年起接受核苷（酸）类似物 +HBIG 联合治疗组患者乙肝复发率为 1.8%（16/902）；四组患者间累积乙肝复发率差异有显著的统计学意义（χ2 ＝ 48.99， P ＝ 0.000），累积存活率的差异也有显著的统计学意义（χ2 ＝ 62.694，P ＝ 0.000）。结论 伴随核苷（酸）类似物及 HBIG 的成功研制上市，我中心肝移植术后预防乙肝复发的治疗方案逐步得到优化完善，核苷（酸）类似物 + HBIG 联合治疗方案可有效预防肝移植术后乙肝复发，并已推广应用至全国，为肝移植术治疗乙肝相关终末期肝病提供有力保障。