乙肝核心抗体阳性供体肾脏在乙肝表面抗体阳性和阴性受者中的应用。

Use of hepatitis B core antibody-positive donor kidneys in hepatitis B surface antibody-positive and -negative recipients.

作者信息

Veroux M, Puliatti C, Gagliano M, Cappello D, Macarone M, Vizcarra D, Spataro M, Di Mare M, Ginevra N, Veroux P

机构信息

Organ Transplant Unit, Department of Surgery, Transplantation and Advanced Technologies, University Hospital of Catania, Catania, Italy.

出版信息

Transplant Proc. 2005 Jul-Aug;37(6):2574-5. doi: 10.1016/j.transproceed.2005.06.068.

DOI:10.1016/j.transproceed.2005.06.068

PMID:16182748

Abstract

INTRODUCTION

The rate of hepatitis B virus transmission via organs from with isolated hepatitis B virus core antibody-positive (HBcAb+) donors in kidney transplant recipients seems very low.

PATIENTS AND METHODS

Over 4 years, we performed 36 transplants from Ig HBcAb+, hepatitis B surface antigen (HBsAg)-negative donors into recipients with a history of prior hepatitis B virus (HBV) infection or reported vaccination (28 patients) and in recipients who were not immunized and received a pretransplant prophylaxis with hepatitis B immunoglobulins. We examined the HBV-related outcomes in these 36 patients in comparison with 40 recipients of allografts from HBcAb- donors.

RESULTS

No patient receiving an allograft from an HBcAb+ donor developed clinical HBV infection or HBSAg positivity. The rate of seroconversion was 14.2% in immunized patients, 12.5% in nonimmunized patients, and 0% in the control group. The 17.8% of immunized patients developed elevated transaminases after transplant, in comparison with 25% and 10% in the nonimmunized patients and the control group, respectively. Graft and patient survival was 93% and 93% for immunized patients, 100% and 100% for nonimmunized patients, and 98% and 95% for the control group, respectively.

CONCLUSION

The use of anti-HBc antibody-positive kidneys was associated with no risk of transmission of HBV infection, without affecting graft and patient survival, and could be considered a safe way to expand the donor pool. Our preliminary results suggest that such kidneys could be safely transplanted even in not immunized patients who underwent a prophylaxis with hepatitis B immunoglobulins.

摘要

引言

在肾移植受者中，通过来自单纯乙肝病毒核心抗体阳性（HBcAb+）供者的器官传播乙肝病毒的发生率似乎非常低。

患者与方法

在4年多的时间里，我们对36例来自Ig HBcAb+、乙肝表面抗原（HBsAg）阴性供者的移植手术进行了研究，受者包括有既往乙肝病毒（HBV）感染史或已报告接种疫苗的患者（28例），以及未接种疫苗且在移植前接受乙肝免疫球蛋白预防治疗的患者。我们将这36例患者的HBV相关结局与40例接受来自HBcAb-供者同种异体移植的受者进行了比较。

结果

接受来自HBcAb+供者同种异体移植的患者均未发生临床HBV感染或HBSAg阳性。免疫接种患者的血清转化率为14.2%，未免疫接种患者为12.5%，对照组为0%。免疫接种患者中有17.8%在移植后转氨酶升高，未免疫接种患者和对照组的这一比例分别为25%和10%。免疫接种患者的移植物和患者生存率分别为93%和93%，未免疫接种患者分别为100%和100%，对照组分别为98%和95%。