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):1963-5. doi: 10.1016/j.transproceed.2012.05.064.
Liver transplantation (LT) with grafts from hepatitis B core antibody (HBcAb)-positive donors has been the object of recent studies, suggesting different outcomes depending on the etiology of viral cirrhosis in the recipient.
From November 2002 to December 2009, we transplanted 124 livers from hepatitis B surface antigen (HBsAg)-negative HBcAb-positive deceased heart-beating donors to adult recipients with viral cirrhosis, classified as: HBsAg positive (group 1; n = 63); hepatitis C virus (HCV) RNA positive (group 2; n = 52); and simultaneously HBsAg and HCV-RNA positive (group 3; n = 9). Immunosuppression included a calcineurin inhibitor, mycophenolate, and steroids (tapered to suspension in 6 months). In all groups, anti-HBV prophylaxis was performed with anti-HBs immunoglobulins and nucleos(t)idic analogues.
The groups were similar regarding donor, recipient, donor-recipient match, transplant procedure, variables, and treatment of acute rejection, except for younger recipient age in group 1 (P = .009), lower recipient body mass index in group 3 (P = .03), and longer cold ischemia time in group 2 (P = .003). Median follow-up for surviving grafts was 63 (range, 16-102) months. No case of recurrent or de novo hepatitis B occurred. The prevalence of histologically proven recurrent HCV hepatitis was similar in groups 2 and 3 (65% vs 78%). Graft survival at 5 years was 86% in group 1, 35% in group 2, and 31% in group 3 (P < .0001 for group 1 vs 2; P < .01 for group 1 vs 3). On multivariate analysis, independent predictors of worse graft survival were HCV infection in the recipient (HR 8.08, 95% CI 3.36-17.97; P < .0001) and MELD at LT ≥25 (HR 3.72, 95% CI 1.12-12.37; P = .032).
The presence of HCV infection in the recipient is the factor which most negatively influenced the outcome of LT using grafts from HBcAb-positive donors. Allocation of such grafts should consider the type of viral cirrhosis among LT candidates.
采用来自乙肝核心抗体（HBcAb）阳性供体的移植物进行肝移植（LT）是近期研究的对象，研究表明，根据受体病毒性肝硬化的病因不同，结果也有所不同。
从2002年11月至2009年12月，我们将124个来自乙肝表面抗原（HBsAg）阴性、HBcAb阳性的脑死亡心跳供体的肝脏移植给患有病毒性肝硬化的成年受体，这些受体分为：HBsAg阳性（第1组；n = 63）；丙型肝炎病毒（HCV）RNA阳性（第2组；n = 52）；以及HBsAg和HCV - RNA同时阳性（第3组；n = 9）。免疫抑制方案包括一种钙调神经磷酸酶抑制剂、霉酚酸酯和类固醇（6个月内逐渐减量至停用）。在所有组中，均采用抗HBs免疫球蛋白和核苷（酸）类似物进行抗HBV预防。
除第1组受体年龄较小（P = 0.009）、第3组受体体重指数较低（P = 0.03）以及第2组冷缺血时间较长（P = 0.003）外，各组在供体、受体、供受体匹配、移植手术、变量以及急性排斥反应的治疗方面相似。存活移植物的中位随访时间为63（范围16 - 102）个月。未发生复发性或新发乙型肝炎病例。组织学证实的复发性丙型肝炎肝炎在第2组和第3组中的患病率相似（65%对78%）。第1组5年移植物存活率为86%，第2组为35%，第3组为31%（第1组与第2组相比，P < 0.0001；第1组与第3组相比，P < 0.01）。多因素分析显示，移植物存活率较差的独立预测因素为受体HCV感染（HR 8.08，95%CI 3.36 - 17.97；P < 0.0001）以及肝移植时终末期肝病模型（MELD）评分≥25（HR 3.72，95%CI 1.12 - 12.37；P = 0.032）。
受体中存在HCV感染是对使用HBcAb阳性供体移植物进行肝移植的结果产生最不利影响的因素。此类移植物的分配应考虑肝移植候选者中病毒性肝硬化的类型。
