儿童活体肝移植受者术后新发乙型肝炎病毒感染的临床研究

涂志越; 孙丽莹; 朱志军; 魏林; 曲伟; 曾志贵; 刘颖; 何恩辉; 张梁; 汪栋; 宋玉伟

doi:10.3969/j.issn.1674-7445.2015.04.008

儿童活体肝移植受者术后新发乙型肝炎病毒感染的临床研究

doi: 10.3969/j.issn.1674-7445.2015.04.008

300070 天津医科大学(涂志越、宋玉伟); 首都医科大学附属北京友谊医院(孙丽莹、朱志军、魏林、曲伟、曾志贵、刘颖、何恩辉、张梁、汪栋)

基金项目:

北京市医院管理局临床技术创新项目 XMLX201302

详细信息

通讯作者:
孙丽莹, Email:sunxlx@outlook.com

中图分类号: R617
计量
- 文章访问数: 102
- HTML全文浏览量: 44
- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2015-05-14
- 网络出版日期: 2021-01-19
- 刊出日期: 2015-07-15

Clinical study of de novo hepatitis B virus infection after pediatric living liver transplantation

Tianjin Medical University, Tianjin 300070, China

More Information

Corresponding author: Sun Liying, Email:sunxlx@outlook.com

摘要

摘要: 目的探讨儿童活体肝移植术后新发乙型肝炎病毒(HBV)感染的临床特点及其防治策略。方法 2010年7月至2014年7月, 在首都医科大学附属北京友谊医院移植中心和天津一中心医院器官移植中心接受活体肝移植术的106例儿童受者纳入本研究, 所有手术由同一外科团队完成。根据供者术前HBV血清学标志物的结果, 将儿童受者分为供肝乙型肝炎核心抗体(抗-HBc)阳性组(45例)和供肝抗-HBc阴性组(61例)。了解两组儿童受者的新发HBV感染情况, 分析供肝抗-HBc阳性组儿童受者新发HBV感染的危险因素, 了解新发HBV感染患儿的特征。结果供肝抗-HBc阳性组和阴性组新发HBV感染发生率分别为18%(8/45)和2%(1/61)。受者术前抗-HBs阴性、术后无抗病毒治疗是抗-HBc阳性供肝受者新发HBV感染的危险因素(均为P < 0.05)。发病距移植手术的中位数时间12个月(8~48个月)。9例儿童受者中, 接受拉米夫定治疗7例, 未予抗病毒治疗2例, 均全部存活。结论应用抗-HBc阳性供肝的儿童肝移植受者, 其术后存在感染HBV的风险。受者术前抗-HBs阴性、术后未给予预防性核苷类似物治疗是抗-HBc阳性供肝受者新发HBV感染的危险因素。接受供体抗-HBc阳性的肝移植儿童受体应使用核苷类似物预防新发HBV感染, 移植术前亦要加强对其接种乙肝疫苗。
- 肝移植 /
- 供肝 /
- 活体 /
- 乙型肝炎核心抗体 /
- 儿童 /
- 乙型肝炎病毒感染, 新发
Abstract: Objective To investigate the clinical characteristics, prevention and treatment strategy of de novo hepatitis B virus (HBV) infection after pediatric living liver transplantation. Methods In total, 106 pediatric recipients undergoing living liver transplantation in Organ Transplantation Center of Affiliated Beijing Friendship Hospital of Capital Medical University and Organ Transplantation Center of Tianjin First Center Hospital from July 2010 to July 2014 were enrolled in this study. All surgeries were performed by the same surgical team. According to preoperative test outcomes of donor HBV serological markers, all recipients were divided into the positive (n=45) and negative (n=61) antibody to hepatitis B core antigen (anti-HBc) donor liver groups(positive group and negative group), and the prevalence of de novo HBV infection was compared between two groups. The risk factors of de novo HBV infection in the positive group were analyzed to elucidate the clinical characteristics of de novo HBV infection in affected children. Results The incidences of de novo HBV infection in positive and negative group were 18%(8/45) and 2%(1/61) respectively. The risk factors of de novo HBV infection in recipients with positive anti-HBc were negative anti-HBs before transplantation and absence of antiviral therapy post-transplantation in recipients (both in P < 0.05). The median interval between time of onset and time of liver transplantation was 12 months (8-48 months). Seven cases were treated with lamivudine and the remaining two cases were left untreated. All nine recipients survived. Conclusions Application of positive anti-HBc donor liver have a risk of HBV infection in recipients after pediatric liver transplantation. Absence of postoperative nucleoside analogue therapy and negative anti-HBs before transplantation acts as risk factors of de novo HBV infection in the recipients with positive anti-HBc donor liver. After liver transplantation, nucleoside analogue therapy is recommended for the pediatric recipients with positive anti-HBc donor liver to prevent the incidence of de novo HBV infection. Besides, hepatitis B vaccine should be administered prior to liver transplantation.
- Liver transplantation /
- Donor liver /
- Living donor /
- Antibody to hepatitis B core antigen /
- Child /
- Hepatitis B virus infection, de novo

HTML全文

表 1 供肝抗-HBc阳性组儿童受者新发HBV感染的危险因素

Table 1. Risk factors of de novo HBV infection in positive Anti-HBc graft group of pediatric recipients[n(%)]

因素	新发HBV感染(n=8)	无新发HBV感染(n=37)	P值
受者术前抗-HBs阴性	5(5/8)	9(24)	0.034
受者术后无抗病毒治疗	8(8/8)	23(62)	0.036

下载: 导出CSV

参考文献(17)

[1]	Skagen CL, Jou JH, Said A. Risk of de novo hepatitis in liver recipients from hepatitis-B core antibody-positive grafts:a systematic analysis[J]. Clin Transplant, 2011, 25(3):E243-E249. doi: 10.1111/ctr.2011.25.issue-3
[2]	Cholongitas E, Ppatheodoridis GV, Burroughs AK. Liver grafts from anti-hepatitis B core positive donors:a systematic review[J]. Hepatol, 2010, 52(2):272-279. doi: 10.1016/j.jhep.2009.11.009
[3]	Liang X, Bi S, Yang W, et al. Evaluation of the impact of hepatitis B vaccination among children born during 1992-2005 in China[J]. Infect Dis, 2009, 200(1):39-47. doi: 10.1086/599173
[4]	Lo CM, Fan ST, Liu CL, et al. Safety and outcome of hepatitis B core antibody-positive donors in right-lobe living donor liver transplantation[J]. Liver Transpl, 2003, 9(8):827-832. doi: 10.1053/jlts.2003.50115
[5]	Chen YS, Wang CC, de Villa VH, et al.Prevention of de novo hepatitis B virus infection in living donor liver transplantation using hepatitis B core antibody positive donors[J]. Clin Transplant, 2002, 16(6):405-409. doi: 10.1034/j.1399-0012.2002.01133.x
[6]	Angelico M, Nardi A, Marianelli T, et al. Hepatitis B-core antibody positive donors in liver transplantation and their impact on graft survival:evidence from the Liver Match cohort study[J]. Hepatol, 2013, 58(4):715-723. doi: 10.1016/j.jhep.2012.11.025
[7]	Xi ZF, Xia Q, Zhang JJ, et al. De novo hepatitis B virus infection from anti-HBc positive donors in pediatric living donor liver transplantation[J]. Dig Dis, 2013, 14(8):439-445. doi: 10.1111/cdd.2013.14.issue-8
[8]	Sun LY, Yang YS, Zhu ZJ, et al. Outcomes in children with biliary atresia following liver transplantation[J]. Hepatobiliary Pancreat Dis Int, 2013, 12(2):143-148. doi: 10.1016/S1499-3872(13)60023-5
[9]	Scuderi V, Ceriello A, Santaniello W, et al. Hepatitis B prophylaxis in hepatitis B-negative recipients transplanted with donor grafts positive for hepatitis B core antibodies[J]. Transplant Proc, 2011, 43(1):271-273. doi: 10.1016/j.transproceed.2010.09.100
[10]	Saab S, Waterman B, Chi AC, et al. Comparison of different immunoprophylaxis regimens after liver transplantation with hepatitis B core antibody-positive donors:a systematic review[J]. Liver Transpl, 2010, 16(3):300-307. http://www.ncbi.nlm.nih.gov/pubmed/20209589
[11]	Rao W, Man Xie, Tao Yang, et al. Risk factors for de novo hepatitis B infection in pediatric living donor liver transplantation[J]. World J Gastroenterol, 2014, 20(36):13159-13166. doi: 10.3748/wjg.v20.i36.13159
[12]	Katsurada A, Marusawa H, Uemoto S, et al.Circulating antibody to hepatitis B core antigen does NOT always reflect the latent hepatitis B virus infection in the liver tissue[J]. Hepatol Res, 2003, 25(2):105-114. doi: 10.1016/S1386-6346(02)00215-2
[13]	Su WJ, Ho MC, Ni YH, et al. High-titer antibody to hepatitis B surface antigen before liver transplantation can prevent de novo hepatitis B infection[J]. Pediatr Gastroenterol Nutr, 2009, 48(2):203-208. doi: 10.1097/MPG.0b013e3181819ad4
[14]	Chang SH, Suh KS, Yi NJ, et al. Active immunization against de novo hepatitis B virus infection in pediatric patients after liver transplantation[J]. Hepatology, 2003, 37(6):1329-1334. doi: 10.1053/jhep.2003.50227
[15]	Park JB, Kwon CH, Lee KW, et al. Hepatitis B virus vaccine switch program for prevention of de novo hepatitis B virus infection in pediatric patients[J]. Transpl Int, 2008, 21(4):346-352. doi: 10.1111/tri.2008.21.issue-4
[16]	Dehghani SM, Shakiba MA, Ziaeyan M, et al. Vaccination status in pediatric liver transplant candidates[J]. Pediatr Transplant, 2009, 13(7):820-822. doi: 10.1111/ptr.2009.13.issue-7
[17]	Ohno Y, Mita A, Ikegami T, et al. Successful active immunization using a hepatitis B virus vaccination protocol for a recipient with hepatitis B core antibody-positive liver graft.[J].Transplant Proc, 2014, 46(3):721-725. doi: 10.1016/j.transproceed.2013.12.005