Objective: To observe the recurrence condition of hepatitis B in different risk groups after liver transplantation in an attempt to provide useful information on whether to discontinue hepatitis B immunoglobulin (HBIG) in the future at an early stage. Methods: The patient population was divided into high, low-risk, and special groups [especially primary hepatocellular carcinoma (HCC)] according to the guidelines for the prevention and treatment of hepatitis B recurrence after liver transplantation. The recurrence condition and risk factors in this population were observed for hepatitis B. Measurement data were analyzed using a t-test and a rank-sum test. Count data were compared using a χ(2) test between groups. Results: This study finally included 532 hepatitis B-related liver transplant cases. A total of 35 cases had HBV recurrence after liver transplantation, including 34 cases that were HBsAg positive, one case that was HBsAg negative, and 10 cases that were hepatitis B virus (HBV) DNA positive. The overall HBV recurrence rate was 6.6%. The recurrence rate of HBV was 9.2% and 4.8% in the high- and low-risk HBV DNA positive and negative groups before surgery (P = 0.057). Among the 293 cases diagnosed with HCC before liver transplantation, 30 had hepatitis B recurrence after surgery, with a recurrence rate of 10.2%. The independent related factors for the recurrence of hepatitis B in patients with HCC after liver transplantation were HCC recurrence (HR =181.92, 95%CI 15.99~2 069.96, P < 0.001), a high postoperative dose of mycophenolate mofetil dispersible tablets (MMF) ( HR =5.190, 95%CI 1.289~20.889, P = 0.020), and a high dosage of HBIG (HR = 1.012, 95%CI 1.001~1.023, P = 0.035). Among the 239 cases who were non-HCC before liver transplantation, five cases (recurrence rate of 2.1%) arouse postoperative hepatitis B recurrence. Lamivudine was used in all cases, combined with on-demand HBIG prophylaxis after surgery. There was no hepatitis B recurrence in non-HCC patients who treated with entecavir combined with HBIG after surgery. Conclusion: High-barrier-to-resistance nucleotide analogues combined with long-term HBIG have a good effect on preventing the recurrence of hepatitis B after liver transplantation. The discontinuation of HBIG may be considered at an early stage after administration of a high-barrier-to-resistance nucleotide analogue in low-risk patients. Domestically, the HBV infection rate is high, so further research is still required to explore the timing of HBIG discontinuation for high-risk patients, especially those with HCC.
目的： 观察不同风险人群在肝移植术后乙型肝炎的复发情况，为以后是否早期停用乙型肝炎免疫球蛋白(HBIG)提供有用信息。 方法： 根据肝移植术后乙型肝炎复发防治指南分为高、低风险人群及特殊人群[尤其原发性肝细胞癌(HCC)]，观察这部分人群乙型肝炎复发情况及复发的危险因素。计量资料组间比较采用t检验、秩和检验；计数资料组间比较采用χ(2)检验。 结果： 最终纳入532例乙型肝炎相关肝移植患者。肝移植术后共35例出现HBV复发，其中HBsAg阳性34例，HBsAg阴性1例，乙型肝炎病毒(HBV) DNA阳性10例。乙型肝炎总的复发率为6.6%。术前HBV DNA阳性的高风险人群乙型肝炎的复发率为9.2%，HBV DNA阴性低风险人群的复发率为4.8% (P = 0.057)。肝移植术前诊断为HCC的293例患者中术后30例出现乙型肝炎复发，复发率为10.2%。HCC患者肝移植术后乙型肝炎复发的独立相关因素为HCC复发(HR = 181.92, 95%CI 15.99～2 069.96, P < 0.001)、术后吗替麦考酚酯分散片(MMF)剂量高(HR = 5.190, 95%CI 1.289～20.889, P = 0.020)和HBIG用量大(HR = 1.012, 95%CI 1.001～1.023, P = 0.035)。肝移植术前非HCC的239例患者中5例患者出现术后乙型肝炎复发(复发率为2.1%)，均为术后应用拉米夫定联合按需HBIG预防治疗的患者，术后恩替卡韦联合HBIG的非HCC患者没有乙型肝炎复发。 结论： 肝移植术后高耐药屏障核苷酸类似物联合长期HBIG预防乙型肝炎复发效果好。对于低风险患者给予高耐药屏障核苷酸类似物后可考虑早期停用HBIG；对于高风险患者，特别是HCC的高风险患者，国内HBV感染率高，尚需进一步研究探索HBIG停药时机。.
Keywords: Hepatitis B; Hepatitis B immunoglobulin; Hepatocellular carcinoma; Liver transplantation; Recurrence; Risk factors.