Soejima Yuji, Shimada Mitsuo, Taketomi Akinobu, Yoshizumi Tomoharu, Uchiyama Hideaki, Ikegami Toru, Nakamuta Makoto, Maehara Yoshihiko
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Liver Int. 2007 Nov;27(9):1282-6. doi: 10.1111/j.1478-3231.2007.01528.x.
BACKGROUND/AIMS: Liver transplantation using a graft from a donor with a positive hepatitis B surface antigen (HBsAg) has been contraindicated owing to the extremely high risk for recurrent disease leading to graft loss. However, the severe shortage of donors often forces the transplant community to utilize suboptimal donors, especially in the setting of living donor liver transplantation (LDLT).
Here, we report a case of successful LDLT for a patient with hepatitis B-related cirrhosis utilizing a graft from an HBsAg-positive 'healthy carrier' donor using a combination prophylaxis of lamivudine and adefovir dipivoxil.
To date, the patient has been doing well with normal liver function tests and liver histological findings at 4 years after the transplantation and the donor has also been doing well.
Although virological recurrence appears to be universal despite prophylaxis, re-evaluation of the use of a graft from a healthy HBsAg-positive donor is warranted in this era of combination prophylaxis.
背景/目的：由于复发疾病导致移植物丢失的风险极高，一直以来都禁忌使用来自乙肝表面抗原（HBsAg）阳性供体的移植物进行肝移植。然而，供体的严重短缺常常迫使移植界使用次优供体，尤其是在活体供肝移植（LDLT）的情况下。
在此，我们报告了一例使用来自HBsAg阳性“健康携带者”供体的移植物，联合使用拉米夫定和阿德福韦酯进行预防，成功为一名乙肝相关性肝硬化患者实施LDLT的病例。
迄今为止，该患者在移植后4年肝功能检查和肝脏组织学检查结果均正常，情况良好，供体也状况良好。
尽管进行了预防，但病毒学复发似乎普遍存在，在这个联合预防的时代，有必要重新评估使用来自健康HBsAg阳性供体的移植物。
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