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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。
Objective To investigate the clinical features and control strategies of new-onset hepatitis B virus (HBV) infection after living donor liver transplantation. Methods From July 2010 to July 2014, 106 children who underwent living donor liver transplantation were enrolled in the transplant center of Beijing Friendship Hospital and Tianjin Center Hospital Organ Transplant Center of Capital Medical University from July 2010 to July 2014. All the operations were performed by the same surgical team carry out. According to the results of preoperative HBV serological markers, the children were divided into donor-resistant hepatitis B core antibody (anti-HBc) positive group (45 cases) and donor liver anti-HBc negative group (61 cases). To understand the newly diagnosed HBV infection in two groups of children, analyze the risk factors of new-onset HBV infection in children with anti-HBc positive group and find out the characteristics of new-onset HBV infection. Results The incidence of new-onset HBV infection was 18% (8/45) and 2% (1/61) respectively in the anti-HBc-positive and negative-donor groups. The recipients were preoperative anti-HBs negative, and no post-antiviral treatment was a risk factor for new-onset HBV infection in anti-HBc-positive donors (all P <0.05). The incidence of transplant surgery from the median time of 12 months (8 to 48 months). Of the 9 children, 7 received lamivudine and 2 did not receive antiviral therapy, all of whom survived. Conclusion Children with anti-HBc positive donor liver transplantation have a risk of HBV infection after operation. Preoperative anti-HBs were negative in recipients and no postoperative prophylactic nucleoside analogue treatment was a risk factor for new-onset HBV infection in anti-HBc-positive donors. Acceptance of donor anti-HBc positive liver transplant recipients should use nucleoside analogs to prevent the development of new-onset HBV infection, transplant patients should also be strengthened before the hepatitis B vaccine.