Tandoi F, Romagnoli R, Martini S, Mazza E, Nada E, Cocchis D, Lupo F, Salizzoni M
Liver Transplant Center, General Surgery Unit, S Giovanni Battista Hospital, University of Turin, Turin, Italy.
Transplant Proc. 2012 Sep;44(7):1960-2. doi: 10.1016/j.transproceed.2012.07.061.
Recent data from Italian studies have shown excellent results of liver transplantation (LT) in hepatitis B virus (HBV)-infected patients with grafts from hepatitis B core antibody (HBcAb)-positive donors, whereas such grafts in hepatitis C virus (HCV)-infected recipients have displayed poorer outcomes. We investigated the results of LT with HBcAb-positive grafts in patients with ongoing HBV and HCV coinfections.
From August 1999 to December 2009, we performed 27 adult primary LTs from deceased heart-beating donors into recipients showing hepatitis B surface antigen (HBsAg)- and HCV-RNA-positivity simultaneously: 12 patients received a graft from an HBsAg-negative HBcAb-positive donor (core+D group) and 15 from an HBcAb-negative donor (core-D group). Immunosuppression included a calcineurin inhibitor, antimetabolite and steroids which were suspended at 6 months. Anti-HBV prophylaxis was always perfomed with anti-HBs immunoglobulins and nucleos(t)idic analogues.
The groups were similar regarding variables of donor, recipient, donor-recipient match, LT procedure, and acute rejection treatment. Median follow-up for surviving grafts was 67 months (range, 16-141). Among all patients, HCV-RNA remained positive after LT. The prevalence of histologically proven recurrent HCV hepatitis was similar in the 2 groups: 83% core+D vs 73% core-D. No recurrent HBV hepatitis occurred during the follow-up. Graft survival at 5 years was significantly lower in the core+D group (core+D 48% vs core-D 87%; P = .018), in which a significantly higher prevalence of graft loss was caused by HCV recurrence (core+D 5/12, 42% vs core-D 1/15, 7%; P = .03). All of the 5 core+D patients who lost their grafts due to HCV recurrence did not receive anti-HCV therapy (4 owing to an aggressive disease and 1 because of patient refusal).
Outcomes of LT in patients with ongoing HBV and HCV coinfection are adversely affected by donor HBcAb positivity, an effect that is mainly mediated by the dismal course of HCV recurrence after LT.
意大利的近期研究数据显示，对于感染乙型肝炎病毒（HBV）的患者，接受来自乙型肝炎核心抗体（HBcAb）阳性供体的肝脏移植（LT）可取得优异的结果，而在丙型肝炎病毒（HCV）感染的受者中，此类移植物的预后较差。我们调查了在同时感染HBV和HCV的患者中使用HBcAb阳性移植物进行LT的结果。
从1999年8月至2009年12月，我们对27例成年原发性LT进行了研究，供体为脑死亡的心跳供体，受者同时呈现乙型肝炎表面抗原（HBsAg）和HCV-RNA阳性：12例患者接受了来自HBsAg阴性、HBcAb阳性供体的移植物（核心抗体阳性供体组），15例接受了来自HBcAb阴性供体的移植物（核心抗体阴性供体组）。免疫抑制包括使用钙调神经磷酸酶抑制剂、抗代谢物和类固醇，这些药物在6个月时停用。抗HBV预防始终采用抗HBs免疫球蛋白和核苷（酸）类似物。
两组在供体、受者、供受者匹配、LT手术和急性排斥反应治疗等变量方面相似。存活移植物的中位随访时间为67个月（范围16 - 141个月）。在所有患者中，LT后HCV-RNA仍为阳性。两组中经组织学证实的复发性HCV肝炎患病率相似：核心抗体阳性供体组为83%，核心抗体阴性供体组为73%。随访期间未发生复发性HBV肝炎。核心抗体阳性供体组5年时的移植物存活率显著较低（核心抗体阳性供体组为48%，核心抗体阴性供体组为87%；P = 0.018），其中因HCV复发导致移植物丢失的患病率显著更高（核心抗体阳性供体组5/12，42%，核心抗体阴性供体组1/15，7%；P = 0.03）。5例因HCV复发而失去移植物的核心抗体阳性供体组患者均未接受抗HCV治疗（4例因病情严重，1例因患者拒绝）。
同时感染HBV和HCV的患者进行LT的预后受到供体HBcAb阳性的不利影响，这种影响主要由LT后HCV复发的不良病程介导。
