Yu Lei, Koepsell Thomas, Manhart Lisa, Ioannou George
Division of Gastroenterology, Department of Medicine, Veterans Affairs Puget Sound Health Care System and University of Washington School of Medicine, Seattle, WA 98195-6424, USA.
Liver Transpl. 2009 Oct;15(10):1343-50. doi: 10.1002/lt.21788.
Liver transplantation using grafts from donors with antibody against hepatitis B core antigen (anti-HBc) increases the recipients' risk of developing hepatitis B virus (HBV) infection post-transplantation. Our aim was to assess whether using such grafts was associated with reduced posttransplantation survival and whether this association depended on recipients' prior exposure to HBV on the basis of their pretransplantation serological patterns. Data were derived from the United Network for Organ Sharing on adult, cadaveric, first-time liver transplants performed between 1994 and 2006. Among recipients who did not have HBV infection before transplantation, those with anti-HBc-positive donors had significantly worse unadjusted posttransplantation patient survival than recipients with anti-HBc-negative donors [hazard ratio, 1.35; 95% confidence interval (CI), 1.21-1.50]. However, after adjustments for other predictors of posttransplantation survival, including donor age, donor race, and recipient underlying liver diseases, patient survival was not significantly different between the 2 groups (hazard ratio, 1.09; 95% CI, 0.97-1.24). Among recipients without antibody against hepatitis B surface antigen (anti-HBs), use of anti-HBc-positive donor grafts was associated with a trend toward worse survival (adjusted hazard ratio, 1.18; 95% CI, 0.95-1.46), whereas no such trend was observed among recipients positive for anti-HBs. In conclusion, in patients without HBV infection before transplantation, using anti-HBc-positive donors was not independently associated with worse posttransplantation survival. Matching these donors to recipients with anti-HBs pre-transplantation may be especially safe.
使用来自抗乙型肝炎核心抗原（抗-HBc）供体的移植物进行肝移植会增加受者移植后发生乙型肝炎病毒（HBV）感染的风险。我们的目的是评估使用此类移植物是否与移植后生存率降低相关，以及这种关联是否取决于受者基于移植前血清学模式的既往HBV暴露情况。数据来源于器官共享联合网络，涉及1994年至2006年间进行的成人尸体首次肝移植。在移植前未感染HBV的受者中，抗-HBc阳性供体的受者未经调整的移植后患者生存率明显低于抗-HBc阴性供体的受者[风险比，1.35；95%置信区间（CI），1.21 - 1.50]。然而，在对移植后生存的其他预测因素进行调整后，包括供体年龄、供体种族和受者潜在肝病，两组患者的生存率无显著差异（风险比，1.09；95% CI，0.97 - 1.24）。在无抗乙型肝炎表面抗原（抗-HBs）抗体的受者中，使用抗-HBc阳性供体移植物与生存趋势较差相关（调整后风险比，1.18；95% CI，0.95 - 1.46），而在抗-HBs阳性的受者中未观察到这种趋势。总之, 在移植前未感染HBV的患者中，使用抗-HBc阳性供体与移植后生存率较差无独立关联。将这些供体与移植前抗-HBs阳性的受者匹配可能特别安全。
