The Clinical Analysis Of Relationship Between Acute Rejection And Recurrence Of Hepatitis B In Liver Transplantation And The Therapy.

Background and objective:With the development of immunosuppressive therapy, the rates of persistence of liver transplantation and of survival after operation have been improved obviously in last decade.But the graft failures occur in 13%of the patients during the first year after operations,and the quantity rise to 35%in 5 years. Graft rejection and recurrence of the primary disease are the two major immunological complications.To make conclusion for the further operations,this research investigated the probability and the relationship of acute rejection and recurrence of hepatitis B of the patients who experience liver transplantations and the clinical manifestations,etc.Methods:A total of 186 cases with liver transplantation in our hospital were retrospectively analyzed between January 2004 and December 2005.165 males,21females.The mean age is 46±9years.Immune depressant used Triple protocol including Cyclosporine or Tacrolimus.Lamivudine combined with Hepatits B Immunoglobin was used to prevent HBV recurrence.AR was diagnosed by histological findings when biopsy was performed for clinical parameters.HBV recurrence is characterized by the appearance of HBsAg in serum after liver transplantation. Results:In this study of the 186 patients,47 patients suffered at least one acute rejection(AR)episode in the followed-up,with a risk of 25.2%.The uncertain AR are 12 cases,light range are 16 cases,midrange are 11 cases,the other are null grouping. These cases had pathologic changes,but the typical clinical manifestations were not obviously.The biochemical changes are lack of specificity.29 patients occurred HBV recurrence,with a risk of 15.6%.Among the 47 cases of patients who suffered AR,3 of them suffered HBV recurrence, and the rate of recurrence is 6.4%.Meanwhile,in the other 139 cases which did not occur AR,26 of them encountered HBV recurrence since the operation,and the rate of recurrence is 18.7%.After analyzing x~2 by SPSS 15.0,the result of P is 0.009.we can figure out the obvious distinction.Conclusions:Though the technique of liver transplantation and immunosuppressive therapy become more mature,some patients with liver transplantation still suffer the complication of acute rejection..The clinical manifestations and biochemical changes are not typical.So the clinician should be alert to the patient who has the liver transplantation.Detect and treat the patients who suffer AR in time. Lamivudine combined with Hepatits B Immunoglobin are the typical therapy to treat the patient who occurred HBV recurrence.Though the probability of recurrence of hepatitis B is low,we should also pay enough attention on the patient who has the liver transplantation.When patients who suffered AR after liver transplantation,we always enforce the dosage of CSA or FK506.And we treat worse patients with high dosage glucocorticosteroid.We inhibit the AR in order to make sure the donator will be the survival of transplantation,and,we give HBV a chance of recurrence.But our research detect that the probability of HBV recurrence of whom suffered AR is envidently lower than that who didn't suffer AR.This phenomenon is relative to the level of immunologic function of their selves...