目的探讨乙型肝炎相关性肝移植患者术后在核苷(酸)类似物联合小剂量乙型肝炎免疫球蛋白的预防下乙型肝炎复发的危险因素及预后。方法 253例乙型肝炎相关性肝移植患者术前即开始给予核苷(酸)类似物预防,术中和术后均给予核苷(酸)类似物联合乙型肝炎免疫球蛋白处理。结果在253例肝移植患者中,死亡29例(11.5%);术前基础病为HBV相关性肝癌患者的病死率为21.2%,显著高于非肝癌患者的5.2%(P=0.000);乙型肝炎复发16例(6.3%);复发后均停用乙型肝炎免疫球蛋白,并调整核苷(酸)类似物,结果患者HBV DNA均<500IU/ml,肝功能稳定;Log-rank检验显示乙型肝炎复发后及时治疗对患者生存无明显影响;经Logistic多因素回归分析表明,术前HBeAg阳性、HBV DNA≥105IU/ml、HCC和HBV/YMDD变异是乙型肝炎复发的危险因素。结论肝移植能够有效治疗乙型肝炎相关性终末期肝病,在核苷(酸)类似物联合乙型肝炎免疫球蛋白预防后,仍有乙型肝炎复发,其对生存率的影响有待于观察。 Objective To investigate the risk factors and prognosis of hepatitis B recurrence in patients with hepatitis B-related liver transplantation after nucleoside (acid) analogue and low-dose hepatitis B immunoglobulin prophylaxis. Methods 253 patients with hepatitis B-related liver transplantation were given prophylactic nucleos (s) analogues preoperatively, nucleoside (acid) analogue and hepatitis B immunoglobulin were given intraoperatively and postoperatively. Results Of the 253 liver transplant recipients, 29 died (11.5%). The preoperative mortality was 21.2% in patients with HBV-related hepatocellular carcinoma (HCC), significantly higher than that in non-HCC patients (5.2%, P = 0.000). Hepatitis B recurrence occurred in 16 cases (6.3%). Hepatitis B immunoglobulin was withdrawn after the relapse and nucleotide (acid) analogue was adjusted. All patients had HBV DNA <500IU / ml and stable hepatic function. The results of Logistic regression analysis showed that preoperative HBeAg positive, HBV DNA≥105IU / ml, HCC and HBV / YMDD mutation were the risk factors of hepatitis B recurrence. Conclusion Liver transplantation can effectively treat hepatitis B-related end-stage liver disease. Hepatitis B recurrence is still observed after nucleoside (acid) analogue combined with hepatitis B immunoglobulin prophylaxis. Its effect on survival rate needs to be observed.