Ju Wei-qiang, He Xiao-shun, Wang Dong-ping, Deng Rong-hai, Wu Lin-wei, Guo Zhi-yong, Zhu Xiao-feng, Huang Jie-fu
Organ Transplantation Center, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510080, China.
Zhonghua Gan Zang Bing Za Zhi. 2012 Jan;20(1):14-6. doi: 10.3760/cma.j.issn.1007-3418.2012.01.006.
To evaluate the outcomes of liver transplant recipients who received liver allografts from hepatitis B surface antigen (HBsAg)-positive donors.
The medical records of 23 male patients (median age, 42.5 years; range: 29-61) who received HBsAg-(+) liver allografts in our organ transplant center were retrospectively analyzed. All patients had confirmed diagnosis of end-stage liver disease (ESLD) secondary to hepatitis B virus (HBV) infection, including 13 HBsAg(+)/HBeAg(-)/HBcAb(+) cases and 10 HBsAg(+)/HBeAb(+)/HBcAb(+) cases. After transplantation, all patients were administered oral entecavir and intravenous anti-hepatitis B immunoglobulin (HBIG) (2000 IU/d during the first week), along with a steroid-free immune suppression regimen. HBV-related antigen and antibody and HBV DNA were detected on post-transplantation days 1, 7, 14, 21, and 30. The liver allografts were monitored by ultrasound imaging. After discharge, monthly follow-up recorded liver function, renal function, acute rejection, infections, vascular complications, biliary complications, HBV recurrence, cancer recurrence, and patient survival.
Two of the recipients died from severe perioperative pneumonia. The remaining 21 recipients were followed-up for 10 to 38 months, and all 21 patients remained HBsAg(+). One recipient developed biliary ischemia and required a second liver transplantation at five months after the primary transplantation. Three recipients (all primary) died from tumor recurrence at 9, 14, and 18 months post-transplantation, respectively. All other recipients survived and had acceptably low HBV DNA copy levels. Color Doppler imaging showed good graft function and normal texture. The patient and graft survival rates were 78.3% (18/23) and 73.9% (17/23), respectively. The recurrence rate of HBV infection was 100% (23/23). In surviving patients, no liver function abnormality, graft loss, or death was found to be related to the recurrence of HBV infection.
Liver transplantation using HBsAg(+) liver grafts was safe for patients with ESLD secondary to HBV infection.
评估接受乙型肝炎表面抗原（HBsAg）阳性供体肝脏移植受者的结局。
回顾性分析了在我们器官移植中心接受HBsAg阳性肝脏移植的23例男性患者（中位年龄42.5岁；范围：29 - 61岁）的病历。所有患者均确诊为乙型肝炎病毒（HBV）感染继发的终末期肝病（ESLD），其中13例为HBsAg(+)/HBeAg(-)/HBcAb(+)病例，10例为HBsAg(+)/HBeAb(+)/HBcAb(+)病例。移植后，所有患者均口服恩替卡韦并静脉注射抗乙型肝炎免疫球蛋白（HBIG）（第一周2000 IU/d），同时采用无类固醇免疫抑制方案。在移植后第1、7、14、21和30天检测HBV相关抗原和抗体以及HBV DNA。通过超声成像监测肝脏移植情况。出院后，每月随访记录肝功能、肾功能、急性排斥反应、感染、血管并发症、胆道并发症、HBV复发、癌症复发和患者生存情况。
2例受者死于严重的围手术期肺炎。其余21例受者随访10至38个月，所有21例患者HBsAg仍为阳性。1例受者发生胆道缺血，在初次移植后5个月需要再次进行肝脏移植。3例受者（均为初次移植）分别在移植后9、14和18个月死于肿瘤复发。所有其他受者存活，且HBV DNA拷贝水平低至可接受程度。彩色多普勒成像显示移植肝功能良好且质地正常。患者和移植肝生存率分别为78.3%（18/23）和73.9%（17/23）。HBV感染复发率为100%（23/2）。在存活患者中，未发现肝功能异常、移植肝丢失或死亡与HBV感染复发有关。
对于HBV感染继发ESLD的患者，使用HBsAg阳性肝脏移植是安全的。
