Fábrega Emilio, García-Suarez Covadonga, Guerra Armando, Orive Aitor, Casafont Fernando, Crespo Javier, Pons-Romero Fernando
Gastroenterology and Hepatology Unit, University Hospital Marqués de Valdecilla, Faculty of Medicine, Santander, Spain.
Liver Transpl. 2003 Sep;9(9):916-20. doi: 10.1053/jlts.2003.50190.
The enduring shortfall of organ donors has inspired the widespread utilization of hepatic allografts from donors with hepatitis B core antibodies in spite of the potential risk of transmitting hepatitis B virus (HBV) infection to the recipient. Here we report a protocol of naive recipients receiving livers from hepatitis B core antibody-positive donors. From November, 1999 to March, 2002, 77 liver transplantations were performed in 73 patients at our institution, 7 of whom received livers from hepatitis B core antibody-positive donors. All recipients received 10,000 U/d of intravenous HBIg for 7 days and 100 mg/d of lamivudine until we could obtain the HBV-DNA from the donor samples (serum and liver tissue). If the results of the HBV-DNA from the donor samples were positive, the patient would continue with prophylaxis and if they were negative we would finish the combined prophylaxis. After transplantation, HBV serologic markers and HBV-DNA by polymerase chain reaction (PCR) in serum and lymphocytes were tested in the recipients on the seventh, fifteenth, thirtieth, and ninetieth days as well as every 3 months after transplantation. All seven donor organs were negative for HBV-DNA in serum and liver tissue. Thus, we stopped the combined prophylaxis in all recipients (range, 7 to 10 days). None of the 7 patients developed de novo HBV infection over the 3-year study period (range, 9 to 36 months). Our approach is reasonably safe, and it appears to be very effective in the prevention of de novo HBV infection after liver transplantation.
尽管存在将乙型肝炎病毒（HBV）感染传播给受者的潜在风险，但器官供体的长期短缺促使人们广泛使用来自乙型肝炎核心抗体阳性供体的肝移植。在此，我们报告了未感染过HBV的受者接受来自乙型肝炎核心抗体阳性供体肝脏的方案。1999年11月至2002年3月，我们机构对73例患者进行了77例肝移植，其中7例接受了来自乙型肝炎核心抗体阳性供体的肝脏。所有受者均接受10000 U/d的静脉注射乙肝免疫球蛋白（HBIg），持续7天，并接受100 mg/d的拉米夫定，直至我们能够从供体样本（血清和肝组织）中获得HBV-DNA。如果供体样本的HBV-DNA结果为阳性，患者将继续进行预防；如果结果为阴性，我们将停止联合预防。移植后，在第7、15、30和90天以及移植后每3个月对受者的血清和淋巴细胞进行HBV血清学标志物检测以及通过聚合酶链反应（PCR）检测HBV-DNA。所有7个供体器官的血清和肝组织HBV-DNA均为阴性。因此，我们在所有受者中停止了联合预防（时间为7至10天）。在为期3年的研究期间（9至36个月），这7例患者均未发生新发HBV感染。我们的方法相当安全，并且在预防肝移植后新发HBV感染方面似乎非常有效。
