Tandoi Francesco, Caviglia Gian Paolo, Pittaluga Fabrizia, Abate Maria Lorena, Smedile Antonina, Romagnoli Renato, Salizzoni Mauro
Liver Transplant Center, General Surgery Unit, Department of Surgical Sciences, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy.
Laboratory of Digestive and Liver Physiopathology, Department of Medical Sciences, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy.
Dig Liver Dis. 2014 Nov;46(11):1020-4. doi: 10.1016/j.dld.2014.07.172. Epub 2014 Sep 16.
Occult hepatitis B virus infection is defined as detectable HBV-DNA in liver of HBsAg-negative individuals, with or without detectable serum HBV-DNA. In deceased liver donors, results of tissue analysis cannot be obtained prior to allocation for liver transplantation.
we investigated prevalence and predictability of occult hepatitis B using blood markers of viral exposure/infection in deceased liver donors.
In 50 consecutive HBsAg-negative/anti-HBc-positive and 20 age-matched HBsAg-negative/anti-HBc-negative donors, a nested-PCR assay was employed in liver biopsies for diagnosis of occult hepatitis B according to Taormina criteria. All donors were characterized for plasma HBV-DNA and serum anti-HBs/anti-HBe.
In liver tissue, occult hepatitis B was present in 30/50 anti-HBc-positive (60%) and in 0/20 anti-HBc-negative donors (p<0.0001). All anti-HBc-positive donors with detectable HBV-DNA in plasma (n=5) or anti-HBs>1,000 mIU/mL (n=5) eventually showed occult infection, i.e, 10/30 occult hepatitis B-positive donors which could have been identified prior to transplantation. In the remaining 40 anti-HBc-positive donors, probability of occult infection was 62% for anti-HBe-positive and/or anti-HBs ≥ 58 mIU/mL; 29% for anti-HBe-negative and anti-HBs<58 mIU/mL.
In deceased donors, combining anti-HBc with other blood markers of hepatitis B exposure/infection allows to predict occult hepatitis B with certainty and speed in one third of cases. These findings might help refine the allocation of livers from anti-HBc-positive donors.
隐匿性乙型肝炎病毒感染定义为乙肝表面抗原阴性个体的肝脏中可检测到乙肝病毒脱氧核糖核酸（HBV-DNA），血清中HBV-DNA可检测到或不可检测到。在已故肝脏供体中，组织分析结果在肝脏移植分配前无法获得。
我们使用已故肝脏供体中病毒暴露/感染的血液标志物调查隐匿性乙型肝炎的患病率和可预测性。
在50例连续的乙肝表面抗原阴性/乙肝核心抗体阳性供体和20例年龄匹配的乙肝表面抗原阴性/乙肝核心抗体阴性供体中，根据陶尔米纳标准，采用巢式聚合酶链反应检测法对肝活检组织进行隐匿性乙型肝炎诊断。所有供体均检测血浆HBV-DNA和血清乙肝表面抗体/乙肝e抗体。
在肝组织中，30/50例乙肝核心抗体阳性供体（60%）存在隐匿性乙型肝炎，20例乙肝核心抗体阴性供体中无1例存在（p<0.0001）。血浆中可检测到HBV-DNA的所有乙肝核心抗体阳性供体（n=5）或乙肝表面抗体>1000 mIU/mL的供体（n=5）最终均显示隐匿性感染，即30例隐匿性乙型肝炎阳性供体中有10例在移植前可被识别。在其余40例乙肝核心抗体阳性供体中，乙肝e抗体阳性和/或乙肝表面抗体≥58 mIU/mL时隐匿性感染概率为62%；乙肝e抗体阴性且乙肝表面抗体<58 mIU/mL时为29%。
在已故供体中，将乙肝核心抗体与其他乙肝暴露/感染血液标志物相结合，可在三分之一的病例中准确且快速地预测隐匿性乙型肝炎。这些发现可能有助于优化乙肝核心抗体阳性供体肝脏的分配。
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