肝移植治疗乙肝相关性肝病 - 三十年的经验。

StephenW

Transpl Infect Dis. 2018 Sep 11:e12997. doi: 10.1111/tid.12997. [Epub ahead of print]
Liver transplantation for Hepatitis-B-associated liver disease - three decades of experience.
Teegen EM1, Maurer MM1, Globke B1, Pratschke J1, Eurich D1.
Author information

1
    Department of Surgery, Charité - Universitätsmedizin, Berlin, Germany.

Abstract
BACKGROUND:

Hepatitis B (HBV)-associated end-stage liver disease used to be a relevant indication for liver transplantation (LT). After transplantation, HBV-reinfection remains a serious issue. Different strategies to prevent HBV-reinfection range from the single application of immunoglobulins (HBIG), to the use of modern nucleoside/nucleotide analogues (NUC) in combination with HBIG, followed by HBIG-discontinuation. The aim of this analysis was to compare different strategies and to sum up the results of 30 years at a high-volume transplant center and deliver additional information on the histopathological level.
METHODS:

Data of 372 liver transplantations performed for the HBV-induced liver disease in 352 patients were extracted from a prospectively organized database. HBV-reinfection was determined in the entire cohort, according to the mode of HBV-prophylaxis. Differences in survival rates were analyzed in patients with successful prophylaxis, untreated and controlled HBV-reinfection. Histopathological results were obtained from protocol biopsies in 151 patients.
RESULTS:

HBV-reinfection was significantly associated with the type of prophylaxis, presence of HBs-Antigen at the moment of LT, transplant year and influencing the overall survival before 2005. After the introduction of modern NUCs, HBV-reinfection stopped to impact HBV-associated transplant loss and survival. Controlled HBV-infection prevents from HBV-associated transplant hepatitis and fibrosis development. The role of HBIG declines in favor of NUCs.
CONCLUSIONS:

Uncontrolled HBV-reinfection does not occur any more. Even in the presence of Hbs-antigen, transplant fibrosis does not develop. The most reliable mode to prevent HBV-recurrence remains the combination of NUCs with a high genetic barrier and HBIG. However, HBIG can safely be discontinued after LT. This article is protected by copyright. All rights reserved.

This article is protected by copyright. All rights reserved.
KEYWORDS:

End-stage liver disease; HBV-recurrence; antiviral agents; graft loss; infectious disease

PMID:
    30203903
DOI:
    10.1111/tid.12997

StephenW

Transpl Infect Dis。 2018年9月11日：e12997。 doi：10.1111 / tid.12997。 [提前打印]
肝移植治疗乙肝相关性肝病 - 三十年的经验。
Teegen EM1，Maurer MM1，Globke B1，Pratschke J1，Eurich D1。
作者信息

1
    Charité外科，德国柏林Universitätsmedizin。

抽象
背景：

乙型肝炎（HBV）相关的终末期肝病曾是肝移植（LT）的相关适应症。移植后，HBV再感染仍然是一个严重的问题。预防HBV再感染的不同策略包括单次应用免疫球蛋白（HBIG），使用现代核苷/核苷酸类似物（NUC）与HBIG联合使用，然后进行HBIG中断。该分析的目的是比较不同的策略，并总结大批量移植中心30年的结果，并提供有关组织病理学水平的其他信息。
方法：

从前瞻性组织的数据库中提取了352例患者中针对HBV诱导的肝病进行的372次肝移植的数据。根据HBV预防的模式，在整个队列中确定HBV再感染。在成功预防，未治疗和控制HBV再感染的患者中分析存活率的差异。组织病理学结果来自151名患者的方案活检。
结果：

HBV再感染与预防类型，LT时刻HBs抗原的存在，移植年份以及影响2005年前的总体存活率显着相关。在引入现代NUC后，HBV再感染停止影响HBV相关移植损失和生存。控制HBV感染可预防HBV相关移植肝炎和纤维化的发展。 HBIG的作用有利于国家自然保护联盟。
结论：

不受控制的HBV再感染不再发生。即使存在Hbs抗原，移植纤维化也不会发展。预防HBV复发的最可靠模式仍然是具有高遗传屏障和HBIG的NUC的组合。但是，LT可以安全地停用HBIG。本文受版权保护。版权所有。

本文受版权保护。版权所有。
关键词：

终末期肝病; HBV-复发;抗病毒药;移植损失;传染病

结论：
    30203903
DOI：
    10.1111 / tid.12997

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