儿童亲属活体肝移植术后EB病毒感染14例临床分析

摘要

Objective To investigate the incidence of Epstein-Barr virus(EBV)infection after pediatric living related liver transplantation and analyze related treatment and prognosis. Methods The medical records of pediatric liver transplant recipients who received living related liver transplantation because of biliary atresia and biliary cirrhosis in Tianjin First Center Hospital during January 1,2012 and December 31,2013 were analyzed retrospectively,with diagnostic standard of positive blood EBV-DNA. The incidence of Epstein-Barr virus infection after pediatric living related liver transplantation and corresponding treatment and prognosis were analyzed. Results 14(16.3%)out of 86 pediatric liver transplant recipients were turned out to be EBV-DNA positive in blood,which were defined as EBV infection,9 cases occurred within the first 3 months after transplantation and 5 after 3 months;when therapy of reducing immunosuppressants and multi antivirus drugs were applied,a total of 13 recipients acquired favorable prognosis,and one case may turn into chronic EBV infection. Conclusion When appropriate immunosuppressants adjustment and antivirus drugs were applied,most pediatric liver transplant recipients who developed EBV infection can acquire satisfying prognosis.%目的探讨儿童亲属活体肝移植术后EB病毒（EBV）感染的发生、治疗及预后情况。方法回顾性分析2012年1月1日至2013年12月31日因胆道闭锁、胆汁淤积性肝硬化于天津市第一中心医院接受亲属活体肝移植术患儿的病历资料和随访资料，以血EBV-DNA阳性为诊断标准，对其中EBV感染的发生、治疗及预后情况进行综合分析。结果86例接受亲属活体肝移植术的患儿中有14例（占16.3％）血EBV-DNA阳性，发生了EBV感染，其中9例发生在术后3个月内，5例发生在术后3个月以后。在应用了免疫抑制药物减量的基础治疗方案和多种抗病毒药物治疗的个体化方案后，13例患儿获得了良好预后效果，1例患儿不排除发生慢性EBV感染的可能。结论在应用了恰当的免疫抑制药物减量方案和抗病毒药物治疗方案后，多数肝移植术后EBV感染患儿预后良好。