Akif ALTINBAŞ, Bernd KRONENBERGER, Ali CANBAY

Hepatit B virus enfeksiyonu nedenli karaciğer nakillerde son yıllardaki değişim

Hepatit B virus (HBV) enfeksiyonu prevelansındaki ve HBV ilişkili mortalitesindeki azalma son yıllarda oldukça dikkat çekicidir. Dünya çapında yaygın olarak uygulanan HBV aşı programları ve HBV’ye karşı kullanımda olan anti-viral ilaçların etkinliği bu başarıda başat rol oynamaktadır. HBV ile mücadelede, sadece HBV’ye bağlı karaciğer fibrozunun ilerlemesi veya geriye döndürülmesi değil, aynı zamanda HBV ilişkili şiddetli akut hepatit tablosunun tedavisinde güzel sonuçlar alınmaktadır. Gelişmekte olan ülkelerde HBV ilişkili siroz karaciğer nakli konusunda halen esas sebep iken, gelişmiş ülkelerde zaman içinde HBV nedenli karaciğer nakil sıklıkları ciddi oranda düşüş göstermiştir. Anti-viral ilaçların karaciğer nakli öncesi etkin kullanımı, HBIg tedavisinin nakil sonrasında yaygın olarak kullanımı sayesinde karaciğer nakli sonrası HBV nüksü, mortalite ve greft kaybı konusunda eskisi kadar sorun olmaktan çıkmıştır. Bu başarının nakil sonrası sürviler üzerine bariz bir yansıması henüz olmamıştır. Buradaki esas sebep ise, alıcı ve verici yaşının son yıllarda önemli oranda artış göstermesi olarak gösterilmektedir. Ekolarak, Milan kriterlerinin yaygın olarak klinik pratiğe girmesiyle karaciğer nakli yapılan hepatosellüler kanser (HCC) hasta sayısı da neredeyse ikiye katlamıştır. Ancak, HCC rekürrensi, nakil sonrası en önemli ölüm nedeni olarak devam etmektedir.

Anahtar Kelimeler:

Hepatit B virus, akut ve kronik HBV enfeksiyonu, siroz, hepatosellüler kanser, karaciğer nakli, aşı

Changes in the relationship between hepatitis B virus and liver transplantation in the last decades

In the last decade, both hepatitis B virus (HBV) prevalence and mortality related to HBV infection have decreased promptly. Worldwide HBV vaccination programs, precautions against HBV transmission and effective anti-viral drugs on market play crucial role for this encouraging result. Besides stopping or reversing the hepato-fibrogenesis induced by HBV infection, fighting against HBV related acute severe hepatitis are also improved recently. HBV associated cirrhosis is still the major cause of LTx, particularly in developing countries,whereas in developed countries, the rate of LTx due to HBV induced cirrhosis has declined over time. With the expanding use of NUCs before LTx, and the use of NUCs and HBIg even after LTx, HBV recurrence after LTx is no longer an important reason for graft loss or patient death. However, this positive impact is not yet reflecting survival, probably because of increasing recipient and donor ages. On the other hand, in the era of Milan criteria, overall hepatocellular carcinoma (HCC) survival has so increased that the number of transplanted HCC cases has almost doubled. However tumor recurrence is still the major cause of death, and treatment is still problematic.

Keywords:

hepatitis B virus, acute or chronic infection, cirrhosis, hepatocellular carcinoma, liver transplantation, vaccine,

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