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