Hwang Shin, Lee Sung-Gyu, Park Kwang-Min, Kim Ki-Hun, Ahn Chul-Soo, Oh Heung-Bum, Moon Deok-Bog, Ha Tae-Yong, Lim Young-Suk, Jung Dong-Hwan
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Liver Transpl. 2006 Jun;12(6):993-7. doi: 10.1002/lt.20799.
The shortage of cadaveric donor organs has led to the use of living donors and marginal cadaveric donors. To date, there have been only 2 reports on the use of hepatitis B surface antigen (HBsAg)-positive liver grafts. Here we describe the 5-yr posttransplantation sequence of a hepatitis B virus (HBV)-positive recipient who received an HBsAg-positive living donor liver graft. A 43-yr-old HBV-positive patient with hepatorenal syndrome received a living donor liver graft in October 2000 from a 27-yr-old HBsAg-positive carrier with no clinical evidence of HBV infection other than the serologic markers. The recipient recovered slowly after liver transplantation (LT). Recipient serum HBsAg was continuously positive despite anti-HBV therapy with high-dose hepatitis B immunoglobulin (HBIG) and lamivudine. The patient was also treated with famciclovir and interferon; to date, a final regimen of lamivudine and adefovir has kept liver function stable for 20 months. The recipient has lived for 64 months after transplantation. The donor has not revealed any clinical evidence of active hepatitis during follow-up. In conclusion, our result implicates that a recipient of liver graft from an HBsAg-positive carrier may survive for a long period following antiviral therapy with lamivudine and adefovir. Considering this living donor case and previously reported cases, the use of an HBsAg-positive cadaveric liver graft may deserve attention when no other donor is available.
尸体供体器官的短缺导致了活体供体和边缘性尸体供体的使用。迄今为止，关于使用乙型肝炎表面抗原（HBsAg）阳性肝脏移植物的报道仅有2例。在此，我们描述了一名接受HBsAg阳性活体供肝移植的乙型肝炎病毒（HBV）阳性受者移植后5年的情况。一名43岁的HBV阳性肝肾综合征患者于2000年10月接受了一名27岁HBsAg阳性携带者的活体供肝移植，该携带者除血清学标志物外无HBV感染的临床证据。受者在肝移植（LT）后恢复缓慢。尽管使用大剂量乙型肝炎免疫球蛋白（HBIG）和拉米夫定进行抗HBV治疗，受者血清HBsAg仍持续呈阳性。患者还接受了泛昔洛韦和干扰素治疗；迄今为止，拉米夫定和阿德福韦的最终治疗方案已使肝功能稳定20个月。受者移植后已存活64个月。供者在随访期间未出现任何活动性肝炎的临床证据。总之，我们的结果表明，接受HBsAg阳性携带者肝脏移植的受者在接受拉米夫定和阿德福韦抗病毒治疗后可能长期存活。考虑到这例活体供肝病例及先前报道的病例，在没有其他供体可用时，使用HBsAg阳性尸体肝脏移植物可能值得关注。
