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Protocol liver biopsies in long-term management of patients transplanted for hepatitis B-related liver disease

World Journal of Gastroenterology 2006年第11期12卷 1706-1712页

作者： stefano targhetta Federico Villamil Paolo Inturri Patrizia Pontisso stefano Fagiuoli Umberto Cillo Attilio Cecchetto Simona Gianni Remo Naccarato Patrizia Burra Gastroenterology Section Department of Surgical and Gastroenterological Sciences University of PadovaItaly Liver Unit Fundacion Favaloro Buenos AiresArgentina Gastroenterology Unit San Bonifacio Hospital VeronaItaly Clinica Medica 5 Department of Clinical and Experimental Medicine University of PadovaItaly Surgery Section Department of Surgical and Gastroenterological Sciences University of PadovaItaly Department of Pathology University of Padova Italy

AIM：To evaluate the long-term histological outcome of patients transplanted for HBV-related liver disease and given HBIg prophylaxis indefinitely after LT. METHODS： Forty-two consecutive patients transplanted for hepatitis B were prospectively studied. HBsAg, HBVDNA and liver function tests were evaluated in the serum 3, 6 and 12 mo after LT and then yearly. LB was obtained 6 and 12 mo after LT and yearly thereafter. Chronic hepatitis （CH） B after LT was classified as minimal, mild, moderate or severe. RESULTS： HBV recurred in 7/42 （16.6%） patients after 6-96 mo of follow-up. A hundred and eightyseven LB were evaluated. Four of 7 patients with graft reinfection, all with unknown HBV DNA status before LT, developed cirrhosis at 12-36 mo of follow-up. Of the 122 LB obtained from 28 HBsAg＋/HCV- recipients with no HBV recurrence after LT, all biopsies were completely normal in only 2 patients （7.1%）, minimal/non-specific changes were observed in 18 （64.2%）, and at least 1 biopsy showed CH in the remaining 8 （28.5%）. Twentynine LB obtained from 7 patients transplanted for HBVHCV cirrhosis and remaining HBsAg- after LT revealed recurrent CH-C. Actuarial survival was similar in patients with HBsAg＋ or HBsAg- liver ***： Though protocol biopsies may enable the detection of graft dysfunction at an early stage, the risk of progression and the clinical significance of these findings remains to be determined.

关键词： Liver transplantation Hepatitis B virus Liverbiopsy Anti-HBs Immunoglobulins

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