Postoperative Hepatitis B Virus Reactivation And Surgery-induced Immunosuppression In Patients With Hepatitis B-related Hepatocellular Carcinoma

Objective:Since resection of patients with hepatocellular carcinoma(HCC)can lead to postoperative hepatitis B virus(HBV)reactivation(PHR)as well as immunosuppression.Whether PHR is associated with immunosuppression is unclear.This study aimed to clarify the relationship between incidence of PHR and its immunosuppression.Thus,to figure out the significance of antiviral therapy on liver function recovery after hepatectomy.Methods:In this prospective study,135 patients scheduled for hepatic resection to treat HBV-related HCC were analyzed for immunosuppression and PHR.As a control group,45 patients who were scheduled for resection to treat hepatic hemangioma were analyzed in the same way.Results:Of the HCC patients,26(19.3%)suffered PHR.The following were identified as significant risk factors for PHR:HBV-cAg S1 positivity[hazard ratio(HR)= 404.82,P = 0.004],high preoperative total bilirubin level(HR = 186.38,P = 0.036),small preoperative proportions of CD3-CD16+CD56+ T cells(HR = 0.01,P = 0.014)and CD19+ B cells(HR =0.02,P = 0.016),blood transfusion(HR = 157.03,P = 0.006)and high liver cirrhosis S score(HR = 270.45,P = 0.004).On postoperative day 3,the lymphocyte profile for PHR patients indicated decreased much larger immune function than the profile for non-PHR patients(T cells:CD3+,CD3+CD4+,CD3+CD8+;B cells:CD19+;IgG,IgA,C3,C4).By postoperative day 7,the lymphocyte profile of PHR patients had improved but not faster than in the non-PHR group(T cells:CD3+,CD3+CD4+,CD3-CD16+CD56+;IgM,C3;C4;.CRP).Conclusion:PHR may be associated with resection-induced immunosuppression in HCC patients.Preoperative antiviral therapy may be useful for reducing the risk of PHR and improve postoperative immune function in HBV-related HCC patients.