Risk factors for hepatitis B virus recurrence after living donor liver transplantation: A 22-year experience at a single center
Risk factors for hepatitis B virus recurrence after living donor liver transplantation: A 22-year experience at a single center
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DOI：
10.5582/bst.2020.03336
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发表时间：
2020-12-01
影响因子：
5.5
通讯作者：
Hasegawa, Kiyoshi
中科院分区：
文献类型：
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作者：
Bae, Sung Kwan;Akamatsu, Nobuhisa;Hasegawa, Kiyoshi
活体肝移植（LDLT）后与乙型肝炎病毒（HBV）复发相关的因素尚未完全阐明。本研究的目的是确定 LDLT 后与 HBV 复发相关的危险因素。自1996年1月至2018年12月，我中心共实施LDLT手术609例。对 70 名因 HBV 相关肝病接受 LDLT 的患者（男性，n = 59；女性，n = 11；中位年龄 = 54 岁）进行回顾性评价。对HBV复发组和非复发组的病毒学和生化数据、肿瘤负荷、抗病毒和免疫抑制治疗进行评估和比较。 70 名患者中有 11 名 (16%) 出现 LDLT 后 HBV 复发。 1年、3年、5年、10年和20年HBV复发的总体精算率分别为0%、13%、16.7%、18.8%和18.8%。 LDLT 与 HBV 复发之间的中位间隔为 57 个月（范围：18-124 个月）。根据单变量和多变量分析，血清 HBV DNA 水平≥ 4 log拷贝/mL（风险比[HR]，4.861；95%置信区间[95% CI]，1.172-20.165；P = 0.029），肝细胞癌（HCC）超出米兰标准（HR，10.083；95% CI， 2.749-36.982；P < 0.001）是 LDLT 后 HBV 复发的独立危险因素。在 LDLT 患者中，LT 前 HBV DNA 水平较高和超出米兰标准的 HCC 是 HBV 复发的危险因素。随着目前 HCC LT 标准的扩大，我们应该对 HBV 复发的风险保持谨慎，特别是在这些人群中。
The factors associated with hepatitis B virus (HBV) recurrence after living donor liver transplantation (LDLT) have not been fully clarified. The aim of this study was to determine the risk factors associated with HBV recurrence after LDLT. From January 1996 to December 2018, a total of 609 LDLT operations were performed at our center. A retrospective review was performed of 70 patients (male, n = 59; female, n = 11; median age = 54 years) who underwent LDLT for HBV-related liver disease. The virologic and biochemical data, tumor burden, antiviral and immunosuppressive therapy were evaluated and compared between the HBV recurrence and non-recurrence groups. Eleven of 70 patients (16%) developed post-LDLT HBV recurrence. The overall actuarial rates of HBV recurrence at 1, 3, 5, 10, and 20 years were 0%, 13%, 16.7%, 18.8%, and 18.8%, respectively. The median interval between LDLT and HBV recurrence was 57 months (range, 18-124 months). Based on the univariate and multivariate analyses, a serum HBV DNA level of >= 4 log copies/mL (hazard ratio [HR], 4.861; 95% confidence interval [95% CI], 1.172-20.165; P = 0.029), and hepatocellular carcinoma (HCC) beyond the Milan criteria (HR, 10.083; 95% CI, 2.749-36.982; P < 0.001) were independent risk factors for HBV recurrence after LDLT. In LDLT patients, high pre-LT HBV DNA levels and HCC beyond the Milan criteria were risk factors for HBV recurrence. With the current expansion of the LT criteria for HCC, we should remain cautious regarding the risk of HBV recurrence, particularly in these groups.