Risk And Prevention Of De Novo Hepatitis B Virus Infection In Pediatric Liver Transplantation

Objective: To study the risk factors and clinical characteristics of de novo hepatitis B infection after liver transplantation in children,and to explore the application of active immunization in the prevention of de novo hepatitis B infection.Methods: This study collected the clinical data of children(<14 years old)who received liver transplantation in Tianjin First Central Hospital from October 2012 to September 2017.The information of patients and donors was collected as follows:(1)donor information: donor demographic data and donor hepatitis B related serological indicators;(2)general information on the recipients: the demo funds of the recipients The preoperative diagnosis,preoperative history of operation and history of blood transfusion,PELD score,and preoperative liver function related biochemical indicators were analyzed before liver transplantation.And liver transplantation donor type,donor origin,graft receptor specific gravity ratio,including intraoperative blood loss,intraoperative erythrocyte and plasma infusion,and intraoperative immunization regimens,etc.(3)postoperative data: liver transplantation recipients in the liver transplant after liver transplantation and the recipients of hepatitis B serological markers Including HBsAb,HBsAg,HBeAg,HBeAb and HBcAb,HBV DNA was detected for patients with positive HBcAb before operation and suspected HBV infection after operation.At the same time,the total bilirubin,alanine aminotransferase,aspartate aminotransferase,and international standardized ratio were detected regularly after liver transplantation.There were no acute rejection after liver transplantation.There were no infection and infection type after operation,and FK506 concentration after operation.Results:(1)a total of 198 patients undergoing liver transplantation were included in this study.The median age was 7 months(5161 month old),and the median follow-up time was 27(11,57)months.There were 107 male recipients and 91 female recipients,and 17 cases of new hepatitis B had a total of 21(11,32)months of new onset hepatitis B,of which 12 cases of new hepatitis B were found in the HBcAb positive donor group,and there was a significant correlation between HBcAb positive and new hepatitis B after liver transplantation(P=0.033,P<0.05).HBsAb positive in children with HBcAb positive donor liver can prevent the occurrence of new hepatitis B(P=0.034,P<0.05)before liver transplantation.The preventive antiviral therapy of oral nucleoside analogues has no significant significance in preventing new hepatitis B.(2)a total of 67 patients were enrolled in the application of HBcAb positive liver transplantation and received active immunization.The median time of follow-up was 31(19,57)months,of which 4 cases had new hepatitis B after liver transplantation,the incidence of which was 5.9%.HBsAb>10U/L was the effective response of children with hepatitis B vaccine inoculated with hepatitis B vaccine before HBcAb positive donor liver transplantation.63 cases of hepatitis B vaccine were vaccinated before liver transplantation,and the number of HBsAb positive children increased from 5.97% before operation to 68.7%.The success rate of serological TBIL before liver transplantation for hepatitis B vaccine was statistically significant(P=0.034,P).<0.05),by multivariate analysis,preoperative TBIL can be used as an independent predictors of effective response to hepatitis B vaccination before surgery(P=0.038,P<0.05).After liver transplantation,HBsAb>200U/L was regarded as an effective response.After liver transplantation,57 patients received hepatitis B vaccine intensive immunization.10 cases had no need to be vaccinated against hepatitis B vaccine for a long time to maintain HBsAb>200U/L.Statistical analysis did not find related factors affecting the success rate of inoculation.Hepatitis B vaccination can effectively prevent the occurrence of new hepatitis B after liver transplantation.Conclusion: The incidence of DNHB after HBcAb positive liver transplantation is significantly higher than that of HBcAb negative donor.The activity of HBV in the transplanted liver tissue of children with DNHB will lead to the increase of acute rejection score,should be treated carefully in the clinic after the pathological examination of the liver.Children with DNHB treated with antiviral therapy was effective.Vacciantion before and after liver transplantation could prevent DNHB after liver transplantation.