移植环境中的慢性乙型肝炎:在意大利单一三级中心30年的经验
Francesco Paolo Russo1,2, Sara Battistella1,2, Alberto Zanetto1,2
1Gastroenterology and Multivisceral Transplant Unit, Azienda Ospedale-Università di Padova, 35125 Padua, Italy.
Viruses
|April 26, 2025
概括
乙型肝炎病毒 (HBV) 是肝移植 (LT) 的主要原因之一. 高屏障核胺类类似物 (hbNUCs) 改善了等候名单患者的治疗结果,使肝细胞癌 (HCC) 成为LT的首要症状.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 移植医学 移植医学
- 病毒学 病毒学
背景情况:
- 乙型肝炎病毒 (HBV) 感染是肝移植 (LT) 的重要驱动因素.
- 接受LT的HBV阳性患者的长期结果需要持续评估.
- 对于HBV患者的LT指示和等待列表 (WL) 管理的趋势正在演变.
研究的目的:
- 评估30年来B型肝炎表面抗原 (HBsAg) 阳性LT接受者的长期患者和移植存活率.
- 分析在15年内被列入LT等待名单 (WL) 的HBsAg阳性患者的趋势和结果.
- 评估型肝炎病毒 (HDV) 同感染和移植指示对LT结局的影响.
主要方法:
- 在帕多瓦医院从1991年到2020年对321名HBsAg阳性LT接受者和284名等候名单患者的回顾性分析.
- 基于HDV共感染的分层,移植指示 (脱偿性肝硬化与肝细胞癌 (HCC)) 和WL纳入期.
- 评估生存率和高屏障核类同类 (hbNUCs) 和移植后预防 (HBIG + NUCs) 的影响.
主要成果:
- 一年和五年患者/移植存活率分别为87.6%/86.7%和82.6%/82.2%.
- 与非HBV患者相比,WL上的HBsAg阳性患者中肝细胞癌 (HCC) 的患病率更高 (p = 0.008).
- hbNUCs显著降低了死亡率 (p = 0.041) 和改善了WL后的生存率 (p = 0.007),在不同指示和共感染中取得了一致的结果.
- 在HBIG + NUCs预防中发生的HBV再激活最小.
结论:
- 乙型肝炎病毒仍然是LT的主要征兆,在30年内患病率一致.
- 引入hbNUCs改善了WL结果,并将主要的LT指示转移到HCC.
- 对于HBV来说,LT后的长期存活率是强大的,无论HDV共感染或特定的适应症.
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