vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2011-2-37-45vtio-372Research ArticleТрансплантомикаTransplantomicsКЛИНИЧЕСКИЕ ВАРИАНТЫ ИНФЕКЦИИ HBV У БОЛЬНЫХ, ПЕРЕНЕСШИХ ТРАНСПЛАНТАЦИЮ ПЕЧЕНИDIFFERENT COURSES OF HBV INFECTION AFTER LIVER TRANSPLANTATIONСюткинВ. Е.SyutkinV. E.vsyutkin@rambler.ruАндрейцеваО. И.AndreytzevaO. I.СалиенкоА. А.SalienkoA. A.ЧугуновА. О.ChugunovA. O.ЧжаоА. В.ChzhaoA. V.Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского, МоскваРоссияN.V. Sklifosovsky Institute research of Emergency Medicine, MoscowRussian Federation201116062014132ВЕСТНИК ТРАНСПЛАНТОЛОГИИ И ИСКУССТВЕННЫХ ОРГАНОВ том XIII No 2–20113745Copyright © Сюткин В.Е., Андрейцева О.И., Салиенко А.А., Чугунов А.О., Чжао А.В., 20112011Сюткин В.Е., Андрейцева О.И., Салиенко А.А., Чугунов А.О., Чжао А.В.Syutkin V.E., Andreytzeva O.I., Salienko A.A., Chugunov A.O., Chzhao A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/372

Проанализировано 104 реципиента, наблюдавшихся более 6 мес. после трансплантации печени (ТП). Возвратная инфекция HBV развилась у 7 (30,4%) из 23 реципиентов, перенесших ТП в связи с HBsAg- положительным заболеванием печени, инфекция HBV de novo – у 11 (13,6%) из 81 HBsAg (–) реципиен- та. Инфекция HBV de novo протекала бессимптомно в 7 (64%) случаях, в виде безжелтушной (1) и жел- тушной (2) форм острого гепатита (ОВГ), у 1 реципиента развился хронический гепатит с исходом в цир- роз трансплантата. Возвратная инфекция HBV протекала бессимптомно у 3 реципиентов, в виде безжел- тушной формы ОВГ – в 4 случаях. HBeAg и IgM анти-HBc наблюдались у 1 (14%) больного с возврат- ной и у 8 (73%) больных с de novo инфекцией HBV. Аналоги нуклеозидов (АН) подавляли репликацию HBV у всех больных. Инфекция HBV de novo у большинства реципиентов протекала циклически и завер- шилась клиренсом HBsAg у 64%, сероконверсией в анти-HBs – у 46% пациентов. Возвратная инфекция HBV протекала как первично хроническая и завершилась клиренсом HBsAg в 1 случае при лечении АН и в одном случае – при лечении Пегасисом. Эффективной стратегией лечения инфекции HBV de novo яв- лялась упреждающая терапия АН, при возвратной инфекции HBV обосновано использование пегилиро- ванного интерферона. 

To compare clinical and virologic course of de novo and recurrent HBV infection 104 liver graft recipients with 6 months and more follow-up after cadaveric transplantation have been analyzed. Recurred HBV infection occurred in 7 (30.4%) out of 23 HBsAg-positive and de novo HBV infection – in 11 out of 81 (13.6%) HBsAg- negative recipients. HBeAg and IgM anti-HBc appeared in 8 recipients with de novo and in one case – with recurrent infection. Two recipients with de novo HBV developed acute hepatitis with jaundice and one – chronic hepatitis with graft cirrhosis. Only one recipient with recurrent HBV developed severe acute hepatitis HBV/ HDV, with anti-HBs seroconversion after 12 weeks of peginterferon alfa treatment. Nucleoside analogs (NA) were started in all 11 de novo HBV cases and in 5 cases of recurrent HBV infection. Treatment with NA effec- tively suppressed HBV DNA replication in both recurrent and de novo infections; HBsAg clearance occurred in 64% of de novo HBV and in 20% – of recurrent HBV cases. No secondary drug resistance occurred. De novo HBV infection is a self-limited disease in most cases, and preemptive NA treatment is the best treatment choice. Recurrent HBV infection is usually chronic, and pegylated interferon may be under consideration as well as NA. 

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The authors declare that there are no conflicts of interest present.