摘要

本文描述了10例肝移植受者移植前有乙肝病毒(HBV)和5例肝移植受者移植前有乙肝病毒和D型肝炎(delta)感染的临床过程。接受8次移植的6名患者死亡。移植前仅携带HBV的患者估计1年和2年生存率分别为74%和67%。HBV和HDV感染患者的预估1年和2年生存率为100%。仅感染HBV的10例患者中有8例发生移植物感染;5例既往有HBV和HDV感染的患者中有4例。从移植到肝脏或血清中出现HBV标记物的时间有很大差异，从6-331天不等。3个移植物分别在移植后4,8,37天迅速出现D型肝炎抗原(HDAg)。在5名受者的6例同种异体移植物中，乙肝病毒感染伴显着肝损伤。特别是，在5个感染的肝脏中，肝细胞由于积累了大量的乙肝表面和核心抗原(HBsAg, HBcAg)而逐渐增大和扭曲。 These features were accompanied by pericellular fibrosis and cholestasis but little associated inflammation. This syndrome carried a poor prognosis. A gradual progression to cirrhosis occurred in one additional liver. Finally, recurrent HBV infection was a principal or a contributing factor in all deaths. The presence of HBcAg and inflammation in he native liver increased the risk of HBV induced tissue damaged in the graft whereas HDV infection in the host liver seemed to reduce the risk of significant HBV induced tissue damage in the allograft. These data suggest that post transplant HBV infection is accompanied by a variety of changes in the liver allograft, some of which are unique to the transplanted liver and may result in impaired allograft function.