CAJ | 학술논문

目的探讨HBsAg阳性供肝在成人肝移植中应用的安全性及其对患者预后的影响.方法回顾性分析本中心2007年1月至2010年2月23例接受HBsAg阳性供肝的成人肝移植患者临床资料,患者全部为男性,中位年龄42.5岁(29 ～ 61岁),原发病均为乙型肝炎相关终末期肝病,其中13例术前HBsAg、HBeAg和抗-HBc为阳性,10例术前HBsAg、抗-HBe和抗-HBc为阳性.供体HBsAg均为阳性,术后口服恩替卡韦0.5mg,1次/d,静脉滴注乙型肝炎免疫球蛋白(HBIG),术后1周每天滴注2000 IU.术中及术后采用无激素的免疫抑制方案,术后第1、7、14、21、30天检测患者血清HBsAg、抗-HBs、HBeAg、抗-HBe、抗-HBc、HBV DNA水平,并行肝脏彩色多普勒超声检查.1个月后每月检测及检查1次,并记录患者术后肝功能、肾功能、急性排斥反应、感染、血管并发症、胆道并发症、乙型肝炎复发、肿瘤复发及患者生存等数据.结果围手术期2例患者死于严重肺部感染,其余21例患者随访至2010年12月(10 ～ 38个月),所有患者术后乙型肝炎未转阴,其中1例患者于术后5个月因胆道缺血再次行肝移植,3例肿瘤患者分别于术后9、14、18个月死于肿瘤复发,18例患者生存,肝功能良好,彩色多普勒超声监测显示肝脏形态、质地良好,HBV DNA监测显示其均为阴性.随访期内,23例患者的生存率为78.3％(18/23),移植肝生存率为73.9％(17/23),未出现乙型肝炎复发所致的肝功能异常、移植肝丢失和病死患者.结论 HBsAg阳性供肝可以安全地应用于乙型肝炎相关终末期肝病的患者.
목적 탐토HBsAg양성공간재성인간이식중응용적안전성급기대환자예후적영향.방법 회고성분석본중심2007년1월지2010년2월23례접수HBsAg양성공간적성인간이식환자림상자료,환자전부위남성,중위년령42.5세(29 ～ 61세),원발병균위을형간염상관종말기간병,기중13례술전HBsAg、HBeAg화항-HBc위양성,10례술전HBsAg、항-HBe화항-HBc위양성.공체HBsAg균위양성,술후구복은체잡위0.5mg,1차/d,정맥적주을형간염면역구단백(HBIG),술후1주매천적주2000 IU.술중급술후채용무격소적면역억제방안,술후제1、7、14、21、30천검측환자혈청HBsAg、항-HBs、HBeAg、항-HBe、항-HBc、HBV DNA수평,병행간장채색다보륵초성검사.1개월후매월검측급검사1차,병기록환자술후간공능、신공능、급성배척반응、감염、혈관병발증、담도병발증、을형간염복발、종류복발급환자생존등수거.결과 위수술기2례환자사우엄중폐부감염,기여21례환자수방지2010년12월(10 ～ 38개월),소유환자술후을형간염미전음,기중1례환자우술후5개월인담도결혈재차행간이식,3례종류환자분별우술후9、14、18개월사우종류복발,18례환자생존,간공능량호,채색다보륵초성감측현시간장형태、질지량호,HBV DNA감측현시기균위음성.수방기내,23례환자적생존솔위78.3％(18/23),이식간생존솔위73.9％(17/23),미출현을형간염복발소치적간공능이상、이식간주실화병사환자.결론 HBsAg양성공간가이안전지응용우을형간염상관종말기간병적환자.
Objective To evaluate the outcomes of liver transplant recipients who received liver allografts from hepatitis B surface antigen (HBsAg)-positive donors.Methods The medical records of 23 male patients (median age,42.5 years; range: 29-61) who received HBsAg-(+) liver allografts in our organ transplant center were retrospectively analyzed.All patients had confirmed diagnosis of end-stage liver disease (ESLD) secondary to hepatitis B virus (HBV) infection,including 13 HBsAg(+)/HBeAg(-)/HBcAb(+) cases and 10 HBsAg(+)/HBeAb(+)/HBcAb(+) cases.After transplantation,all patients were administered oral entecavir and intravenous anti-hepatitis B immunoglobulin (HBIG) (2000 IU/d during the first week),along with a steroid-free immune suppression regimen.HBV-related antigen and antibody and HBV DNA were detected on post-transplantation days 1,7,14,21,and 30.The liver allografts were monitored by ultrasound imaging.After discharge,monthly follow-up recorded liver function,renal function,acute rejection,infections,vascular complications,biliary complications,HBV recurrence,cancer recurrence,and patient survival.Two of the recipients died from severe perioperative pneumonia.The remaining 21 recipients were followed-up for 10-38 months,and all 21 patients remained HBsAg(+).One recipient developed biliary ischemia and required a second liver transplantation at five months after the primary transplantation.Three recipients (all primary) died from tumor recurrence at 9,14,and 18 months post-transplantation,respectively.All other recipients survived and had acceptably low HBV DNA copy levels.Color Doppler imaging showed good graft function and normal texture.The patient and graft survival rotes were 78.3％ (18/23) and 73.9％ (17/23),respectively.The recurrence rote of HBV infection was 100％ (23/23).In surviving patients,no liver function abnormality,graft loss,or death was found to be related to the recurrence of HBV infection.Conclusion Liver transplantation using HBsAg(+) liver grafts was safe for patients with ESLD secondary to HBV infection.