HBsAg阳性供者供肝用于乙型肝炎合并超UCSF标准肝癌肝移植20例  

Application of liver grafts from HBsAg positive donors in liver transplantation for hepatocellular carcinoma beyond UCSF Criteria

作　　者：陈新国[1] 沈中阳[2] 牛玉坚[1] 单姗[1] 王乐天[1] 李莉[1] 李君[1] 

机构地区：[1]武警总医院器官移植研究所,北京100039 [2]天津市第一中心医院

出　　处：《中华器官移植杂志》2013年第9期528-531,共4页Chinese Journal of Organ Transplantation

基　　金：国家高技术研究发展计划（863计划）（2012AA021006）

摘　　要：目的探讨乙型肝炎病毒表面抗原（HBsAg）阳性供者供肝在超加利福尼亚大学洛杉矶分校（UCSF）标准肝癌且术前血清HBsAg均为阳性者肝移植中的应用效果。方法2008年10月至2012年12月间，20例乙型肝炎合并超UCSF标准肝癌患者接受了HBsAg阳性供肝移植。回顾性分析受者术后乙型肝炎病毒（HBV）复制情况、移植物功能、肿瘤复发和生存情况等。结果20例中，1例失随访，其他19例随访至2013年6月，中位随访时间为12个月（2-57个月）。5例受者存活，4例为无肿瘤复发存活，其中3例已分别无肿瘤复发存活57、35和26个月；1例因术后发生腹腔出血和多器官功能衰竭于术后第21天死亡，其他13例均于术后不同时期死于肿瘤复发。19例术后单用恩替卡韦抗HBV治疗，1例联合使用阿德福韦酯。受者术后45d时血清HBsAg均为阳性，HBVDNA均为阴性，肝功能酶学指标和胆红素及凝血功能均恢复至正常或在正常上限值2倍之内。随访期内受者血清HBsAg均为阳性，但未见乙型肝炎复发。移植受者1、2、3和4年累积存活率分别为48．0％、35．0％、18．7％和18．7％。结论HBsAg阳性供者供肝可选择性地用于乙型肝炎合并超UCSF标准肝癌患者，可在一定程度上延长受者生命、改善生活质量，甚至获得长期无肿瘤复发生存；该类受者术后应给予强效抗HBV治疗。Objective To evaluate the outcomes of liver transplant recipients who received liver grafts from HBsAg positive donors in patients with hepatocellular carcinoma beyond UCSF （University of California, San Francisco） Criteria. Method The medical records of patients who underwent HBsAg-positive donor liver transplantation for hepatocellular carcinoma beyond UCSF Criteria from October 2008 to December 2012 at our hospital were analyzed retrospectively, including the existence status of HBV, graft function, tumor recurrence, and the survival after transplantation. Result A total of 20 patients were enrolled in the study. One patient lost follow-up while the remaining 19 patients had complete follow-up data. All the patients were followed up until June 2013, with a median follow-up duration of 12 months （range 2-57 months）. One patient died from postoperative abdominal bleeding and multiple organ failure at post-transplantative day 21. Five patients survived up to now, including 4 cases with disease-free survival, who has been surviving for 57, 35, 26 and 12 months respectively. The remaining all 14 patients died from tumor recurrence at different time points after transplantation. Entecavir was used alone in 19 patients and Entecavir combined with Adefovir dipivoxilalone were used as anti-HBV therapy in the recipients. At post- transplant day 45, all the recipients were positive for serum HBsAg and negative for serum HBV DNA, and the liver enzymatic criteria, coagulation criteria and the serum hilirubin restored to normal levels or within twice the upper limit of normal levels. Throughout the follow-up period, recipients were all positive for serum HBsAg, but there was no recurrence of hepatitis B. The 1 , 2-, 3- and 4 year cumulative survival rate was 48.0%, 35.0%, 18.7% and 18.7% respectively. Conclusion The HBsAg positive liver may be used as a donor in liver transplantation and the graft probably works well after the operation. Liver transplantation may prolong the survival and improve the quality of life,

关 键 词：癌 肝细胞 肝移植 肝炎表面抗原 乙型 移植物存活 供者选择 

分 类 号：R512.62[医药卫生—内科学]