CAJ | 학술논문

目的探讨乙型肝炎病毒表面抗原(HBsAg)阳性供者供肝在超加利福尼亚大学洛杉矶分校(UCSF)标准肝癌且术前血清HBsAg均为阳性者肝移植中的应用效果.方法 2008年10月至2012年12月间,20例乙型肝炎合并超UCSF标准肝癌患者接受了HBsAg阳性供肝移植.回顾性分析受者术后乙型肝炎病毒(HBV)复制情况、移植物功能、肿瘤复发和生存情况等.结果 20例中,1例失随访,其他19例随访至2013年6月,中位随访时间为12个月(2～57个月).5例受者存活,4例为无肿瘤复发存活,其中3例已分别无肿瘤复发存活57、35和26个月；1例因术后发生腹腔出血和多器官功能衰竭于术后第21天死亡,其他13例均于术后不同时期死于肿瘤复发.19例术后单用恩替卡韦抗HBV治疗,1例联合使用阿德福韦酯.受者术后45 d时血清HBsAg均为阳性,HBV DNA均为阴性,肝功能酶学指标和胆红素及凝血功能均恢复至正常或在正常上限值2倍之内.随访期内受者血清HBsAg均为阳性,但未见乙型肝炎复发.移植受者1、2、3和4年累积存活率分别为48.0％、35.0％、18.7％和18.7％.结论 HBsAg阳性供者供肝可选择性地用于乙型肝炎合并超UCSF标准肝癌患者,可在一定程度上延长受者生命、改善生活质量,甚至获得长期无肿瘤复发生存；该类受者术后应给予强效抗HBV治疗.
목적 탐토을형간염병독표면항원(HBsAg)양성공자공간재초가리복니아대학락삼기분교(UCSF)표준간암차술전혈청HBsAg균위양성자간이식중적응용효과.방법 2008년10월지2012년12월간,20례을형간염합병초UCSF표준간암환자접수료HBsAg양성공간이식.회고성분석수자술후을형간염병독(HBV)복제정황、이식물공능、종류복발화생존정황등.결과 20례중,1례실수방,기타19례수방지2013년6월,중위수방시간위12개월(2～57개월).5례수자존활,4례위무종류복발존활,기중3례이분별무종류복발존활57、35화26개월；1례인술후발생복강출혈화다기관공능쇠갈우술후제21천사망,기타13례균우술후불동시기사우종류복발.19례술후단용은체잡위항HBV치료,1례연합사용아덕복위지.수자술후45 d시혈청HBsAg균위양성,HBV DNA균위음성,간공능매학지표화담홍소급응혈공능균회복지정상혹재정상상한치2배지내.수방기내수자혈청HBsAg균위양성,단미견을형간염복발.이식수자1、2、3화4년루적존활솔분별위48.0％、35.0％、18.7％화18.7％.결론 HBsAg양성공자공간가선택성지용우을형간염합병초UCSF표준간암환자,가재일정정도상연장수자생명、개선생활질량,심지획득장기무종류복발생존；해류수자술후응급여강효항HBV치료.
Objective To evaluate the outcomes of liver transplant recipients who received liver grafts from HBsAg positive donors in patients with hepatocellular carcinoma beyond UCSF (University of California,San Francisco) Criteria.Method The medical records of patients who underwent HBsAg-positive donor liver transplantation for hepatocellular carcinoma beyond UCSF Criteria from October 2008 to December 2012 at our hospital were analyzed retrospectively,including the existence status of HBV,graft function,tumor recurrence,and the survival after transplantation.Result A total of 20 patients were enrolled in the study.One patient lost follow-up while the remaining 19 patients had complete follow-up data.All the patients were followed up until June 2013,with a median follow-up duration of 12 months (range 2-57 months).One patient died from postoperative abdominal bleeding and multiple organ failure at post-transplantative day 21.Five patients survived up to now,including 4 cases with disease-free survival,who has been surviving for 57,35,26 and 12 months respectively.The remaining all 14 patients died from tumor recurrence at different time points after transplantation.Entecavir was used alone in 19 patients and Entecavir combined with Adefovir dipivoxilalone were used as anti-HBV therapy in the recipients.At posttransplant day 45,all the recipients were positive for serum HBsAg and negative for serum HBVDNA,and the liver enzymatic criteria,coagulation criteria and the serum bilirubin restored to normal levels or within twice the upper limit of normal levels.Throughout the follow-up period,recipients were all positive for serum HBsAg,but there was no recurrence of hepatitis B.The 1-,2-,3-and 4-year cumulative survival rate was 48.0％,35.0％,18.7％ and 18.7％ respectively.Conclusion The HBsAg positive liver may be used as a donor in liver transplantation and the graft probably works well after the operation.Liver transplantation may prolong the survival and improve the quality of life,even achieve long-term disease-free survival in patients with hepatocellular carcinoma beyond UCSF Criteria.The use of nucleotide analogue only,instead of combination with hepatitis B immune globulin,can also bring HBV well under control in liver transplant recipients with HBsAg positive donors.