探究乙型病毒性肝炎(以下简称乙肝)相关终末期肝病肝移植受者术后乙肝复发情况及其影响因素。

回顾性收集2016年1月至2024年12月因乙肝相关终末期肝病于安徽医科大学第一附属医院接受肝移植治疗的138例患者临床资料。根据术后是否出现乙肝复发分为复发组(n＝13例)和无复发组(n＝125例)。采用方差齐性检验判断两组数据的离散程度是否一致，若方差齐(P>0.05)，组间比较采用成组t检验；若方差不齐(P≤0.05)，组间比较采用校正t检验。非正态分布计量资料组间比较采用Mann-Whitney U检验。计数资料组间比较采用卡方检验。采用logistic回归分析肝移植术后乙肝复发危险因素。使用Kaplan-Meier法绘制生存曲线并采用log-rank检验进行比较。P<0.05为差异具有统计学意义。

随访截至2025年12月31日，中位随访时间为39.8(7.7，116.7)个月。复发组术后1年内他克莫司血药浓度和术后并发症发生比例分别为(9.54±1.87)ng/mL和84.6%(11/13)，无复发组分别为(7.97±2.22)ng/mL和53.6%(67/125)，差异均有统计学意义(t＝－2.461，χ²＝4.609，P均<0.05)。多因素logistic回归分析结果示，术后1年内他克莫司血药浓度(OR＝1.500，95%CI：1.050~2.141)是影响术后乙肝复发的危险因素，差异有统计学意义(P<0.05)。138例受者1、3、5年累积生存率分别为97.8%、90.7%和81.7%。随访期间复发组3例受者死亡，分别死于肝癌肝内复发、肝癌肝内复发合并肺部转移及乙肝复发导致的暴发性肝功能衰竭；无复发组14例死亡，4例死于多器官功能衰竭，3例死于肝癌复发后疾病进展所致肝功能衰竭，3例死于免疫排斥反应所致肝功能衰竭，3例死于胆道并发症，1例死于消化道出血。复发组受者1、3、5年累积生存率分别为92.3%、84.6%和76.2%，无复发组分别为97.6%、91.5%和82.5%。截至随访终点，两组受者累积生存率差异无统计学意义(χ²＝0.709，P>0.05)。

肝移植术后1年内他克莫司血药浓度较高可能是影响乙肝相关肝移植受者术后乙肝复发的危险因素。

To investigate postoperative hepatitis B recurrence and its risk factors in liver transplant recipients with HBV-related end-stage liver disease.

Clinical data of 138 recipients, who underwent liver transplantation for HBV-related end-stage liver disease at the First Affiliated Hospital of Anhui Medical University from January 2016 to December 2024, were retrospectively collected. Recipients were divided into a recurrence group (n=13) and a non-recurrence group (n=125) based on the presence or absence of postoperative hepatitis B recurrence. The homogeneity of variances between the two groups was assessed using Levene′s test. When variances were equal (P>0.05), comparisons between groups were performed using the group t-test; when variances were unequal (P≤0.05), the adjusted t-test was used. For continuous data with a non-normal distribution, the Mann-Whitney U test was used for intergroup comparisons. Categorical data were compared using the chi-square test. Logistic regression analysis was used to identify risk factors for postoperative hepatitis B recurrence. Survival curves were plotted using the Kaplan-Meier method and compared using the log-rank test. A P-value < 0.05 was considered statistically significant.

Follow-up was conducted until December 31, 2025, with a median follow-up duration of 39.8 (7.7, 116.7) months. Statistically significant differences were observed between the two groups in mean serum tacrolimus concentration [(9.54±1.87) and (7.97±2.22) ng/mL] within the first postoperative year and the incidence [84.6%(11/13) and 53.6% (67/125) ] of postoperative complications (t=-2.461, χ²=4.609, all P<0.05). Multivariate logistic regression analysis revealed that serum tacrolimus concentration within the first postoperative year (OR=1.500, 95%CI: 1.050-2.141) was an independent risk factor for postoperative hepatitis B recurrence in HBV-related liver transplant recipients (P<0.05). The 1-, 3-, and 5-year cumulative overall survival rates for the 138 recipients were 97.8%, 90.7% and 81.7%, respectively. During follow-up, three recipients in the recurrence group died due to intrahepatic recurrence of hepatocellular carcinoma, intrahepatic hepatocellular carcinoma recurrence with pulmonary metastasis, and fulminant liver failure caused by HBV reactivation. There were 14 recipients died in the non-recurrence group: 4 died of multiple organ failure, 3 died of liver failure caused by disease progression following hepatocellular carcinoma recurrence, 3 died of liver failure secondary to immune rejection, 3 died of biliary complications, and 1 died of gastrointestinal hemorrhage. The 1-, 3-, and 5-year cumulative survival rates of recipients were 92.3%, 84.6% and 76.2% in the recurrence group, and 97.6%, 91.5% and 82.5% in the non-recurrence group. The log-rank test showed no statistically significant difference in cumulative survival was observed between the two groups at follow-up endpoint(χ²=0.709, P>0.05).

Higher mean serum tacrolimus concentration within the first postoperative year may be a risk factor for postoperative hepatitis B recurrence in liver transplant recipients with HBV-related disease.