Chan P C, Lok A S, Cheng I K, Chan M K
Department of Medicine, University of Hong Kong.
Transplantation. 1992 Jan;53(1):128-31. doi: 10.1097/00007890-199201000-00025.
Ninety-eight renal transplant recipients who had been followed for 1-6.5 years (median 3.2 years) were reviewed to determine the effect of donor and recipient hepatitis B surface antigen status on the incidence of hepatitis and on patient survival. The cumulative risk of developing hepatitis posttransplant was significantly higher in hepatitis B surface antigen-positive versus hepatitis B surface antigen-negative patients (P = 0.001). Nine (60%) of 15 patients who were hepatitis B surface antigen-positive prior to transplantation, 3 (75%) of 4 patients who became hepatitis B surface antigen-positive after transplantation, and 17 (22%) of 79 patients who were persistently hepatitis B surface antigen-negative developed hepatitis posttransplant. Five hepatitis B surface antigen-negative patients received allografts from hepatitis B surface antigen-positive donors. None of the five, including one who was initially seronegative, became hepatitis B surface antigen-positive posttransplant. Of the four patients who became HBsAg-positive posttransplant, three received kidneys from donors of unknown HBsAg status in China, while one was transplanted with a kidney from a HBsAg-negative donor. In summary, we found that the risk of developing hepatitis after renal transplantation was significantly higher in hepatitis B surface antigen-positive patients. However, both patient and graft survival were similar in hepatitis B surface antigen-positive and hepatitis B surface antigen-negative patients. The transplantation of kidneys from HBsAg-positive donors to HBsAg-negative patients did not result in clinically significant hepatitis or chronic HBsAg carriage. De novo hepatitis B infection may arise from sources other than the kidney itself.
对98例接受肾移植且随访1至6.5年（中位时间3.2年）的患者进行回顾性研究，以确定供体和受体乙肝表面抗原状态对肝炎发病率及患者生存率的影响。移植后发生肝炎的累积风险在乙肝表面抗原阳性患者中显著高于乙肝表面抗原阴性患者（P = 0.001）。移植前乙肝表面抗原阳性的15例患者中有9例（60%）、移植后乙肝表面抗原转阳的4例患者中有3例（75%）以及持续乙肝表面抗原阴性的79例患者中有17例（22%）在移植后发生肝炎。5例乙肝表面抗原阴性患者接受了来自乙肝表面抗原阳性供体的移植物。这5例患者中，包括1例最初血清学阴性的患者，移植后均未出现乙肝表面抗原阳性。在4例移植后乙肝表面抗原转阳的患者中，3例在中国接受了来自乙肝表面抗原状态不明供体的肾脏，1例接受了来自乙肝表面抗原阴性供体的肾脏。总之，我们发现肾移植后乙肝表面抗原阳性患者发生肝炎的风险显著更高。然而，乙肝表面抗原阳性和阴性患者的患者及移植物生存率相似。将乙肝表面抗原阳性供体的肾脏移植给乙肝表面抗原阴性患者并未导致具有临床意义的肝炎或慢性乙肝表面抗原携带。新发乙肝感染可能源于肾脏本身以外的其他来源。
