Liver Unit, Tor Vergata University, Rome, Italy.
J Hepatol. 2013 Apr;58(4):715-23. doi: 10.1016/j.jhep.2012.11.025. Epub 2012 Nov 28.
BACKGROUND & AIMS: The appropriate allocation of grafts from HBcAb positive donors in liver transplantation is crucial, yet a consensus is still lacking.
We evaluated this issue within Liver Match, a prospective observational Italian study. Data from 1437 consecutive, first transplants performed in 2007-2009 using grafts from deceased heart beating donors were analyzed (median follow-up: 1040 days). Of these, 219 (15.2%) were HBcAb positive. Sixty-six HBcAb positive grafts were allocated to HBsAg positive and 153 to HBsAg negative recipients.
329 graft losses occurred (22.9%): 66 (30.1%) among 219 recipients of HBcAb positive grafts, and 263 (21.6%) among 1218 recipients of HBcAb negative grafts. Graft survival was lower in recipients of HBcAb positive compared to HBcAb negative donors, with unadjusted 3-year graft survival of 0.69 (s.e. 0.032) and 0.77 (0.013), respectively (log-rank, p=0.0047). After stratifying for recipient HBsAg status, this difference was only observed among HBsAg negative recipients (log rank, p=0.0007), 3-year graft survival being excellent (0.88, s.e. 0.020) among HBsAg positive recipients, regardless of the HBcAb donor status (log rank, p=0.4478). Graft loss due to de novo HBV hepatitis occurred only in one patient. At Cox regression, hazard ratios for graft loss were: MELD (1.30 per 10 units, p=0.0002), donor HBcAb positivity (1.56, p=0.0015), recipient HBsAg positivity (0.43, p <0.0001), portal vein thrombosis (1.99, p=0.0156), and DRI (1.41 per unit, p=0.0325).
HBcAb positive donor grafts have better outcomes when transplanted into HBsAg positive than HBsAg negative recipients. These findings suggest that donor HBcAb positivity requires more stringent allocation strategies.
在肝移植中，从 HBcAb 阳性供体中适当分配移植物至关重要，但仍缺乏共识。
我们在意大利前瞻性观察性研究 Liver Match 中评估了这一问题。分析了 2007-2009 年间使用来自心脏跳动供体的移植物进行的 1437 例连续首次移植的数据（中位随访时间：1040 天）。其中 219 例（15.2%）HBcAb 阳性。66 例 HBcAb 阳性移植物分配给 HBsAg 阳性患者，153 例分配给 HBsAg 阴性患者。
发生 329 例移植物丢失（22.9%）：219 例 HBcAb 阳性受者中有 66 例（30.1%），1218 例 HBcAb 阴性受者中有 263 例（21.6%）。与 HBcAb 阴性供体相比，HBcAb 阳性供体的移植物存活率较低，未经调整的 3 年移植物存活率分别为 0.69（s.e. 0.032）和 0.77（0.013）（对数秩，p=0.0047）。在按受者 HBsAg 状态分层后，仅在 HBsAg 阴性受者中观察到这种差异（对数秩，p=0.0007），HBsAg 阳性受者的 3 年移植物存活率极佳（0.88，s.e. 0.020），无论 HBcAb 供体状态如何（对数秩，p=0.4478）。由于新发生的乙型肝炎病毒肝炎导致的移植物丢失仅发生在 1 例患者中。在 Cox 回归中，移植物丢失的风险比为：MELD（每增加 10 单位，1.30，p=0.0002），供体 HBcAb 阳性（1.56，p=0.0015），受者 HBsAg 阳性（0.43，p<0.0001），门静脉血栓形成（1.99，p=0.0156）和 DRI（每单位增加 1.41，p=0.0325）。
与 HBsAg 阴性受者相比，HBcAb 阳性供体的移植物在移植到 HBsAg 阳性受者中时具有更好的结局。这些发现表明，供体 HBcAb 阳性需要更严格的分配策略。
