Yilmaz V T, Aliosmanoglu I, Erbis H, Ulger B V, Cetinkaya R, Suleymanlar G, Kocak H
Department of Internal Medicine, Division of Nephrology, Akdeniz University Medical School, Antalya, Turkey.
Department of General Surgery, Akdeniz University Medical School, Antalya, Turkey.
Transpl Infect Dis. 2016 Feb;18(1):55-62. doi: 10.1111/tid.12482. Epub 2016 Jan 30.
The aim of this study was to determine the effects of hepatitis B surface antigen (HBsAg) positivity of the donors on graft survival and liver complications in HBsAg(+) renal transplant recipients.
A group of 55 patients who underwent renal transplantation (RTx) in our hospital between 2001 and 2012 were included in the study. Patients were divided into 2 groups. Group 1 (n = 50) consisted of HBsAg(+) renal transplant recipients (RTR) whose donors were HBsAg(-). In Group 2 (n = 5), RTR and donors were both HBsAg(+). Lymphocyte cross matches, number of mismatches, donor types, renal replacement treatment modalities, drugs of induction treatment, and preoperative hepatitis B virus DNA titers of the groups were similar. In Group 1, 42 patients were taking lamivudine, 3 patients were taking entecavir, and 5 patients were taking tenofovir. All of the patients in Group 2 were taking lamivudine. Patient and graft survival rates, graft functions, acute hepatitis rates, acute rejection rates, and other clinical outcomes of the groups were compared.
Demographic data of the groups were similar. Acute rejection rates (P = 0.458), graft survival rates (P = 0.515), and patient survival rates (P = 0.803) were also similar. No significant difference was found between the groups in terms of acute hepatitis rate (P = 0.511), glomerular filtration rate (calculated by Modification of Diet in Renal Disease formula) in the last follow-up (P = 0.988), alanine aminotransferase levels (P = 0.069), or delayed graft function rate (P = 0.973). Rates of chronic allograft dysfunction and new onset diabetes mellitus after transplantation were similar.
Our study revealed that, RTx from HBsAg(+) donors to HBsAg(+) recipients is safe with antiviral treatment.
本研究旨在确定供体乙肝表面抗原（HBsAg）阳性对HBsAg阳性肾移植受者移植物存活及肝脏并发症的影响。
纳入2001年至2012年期间在我院接受肾移植（RTx）的55例患者。患者分为2组。第1组（n = 50）为供体HBsAg阴性的HBsAg阳性肾移植受者（RTR）。第2组（n = 5）中，RTR和供体均为HBsAg阳性。两组的淋巴细胞交叉配型、错配数量、供体类型、肾脏替代治疗方式、诱导治疗药物以及术前乙肝病毒DNA滴度相似。第1组中，42例患者服用拉米夫定，3例患者服用恩替卡韦，5例患者服用替诺福韦。第2组所有患者均服用拉米夫定。比较两组患者及移植物存活率、移植物功能、急性肝炎发生率、急性排斥反应发生率及其他临床结局。
两组的人口统计学数据相似。急性排斥反应发生率（P = 0.458）、移植物存活率（P = 0.515）和患者存活率（P = 0.803）也相似。两组在急性肝炎发生率（P = 0.511）、末次随访时的肾小球滤过率（采用肾脏病饮食改良公式计算）（P = 0.988）、丙氨酸转氨酶水平（P = 0.069）或移植肾功能延迟恢复发生率（P = 0.973）方面均无显著差异。慢性移植物功能障碍发生率和移植后新发糖尿病发生率相似。
我们的研究表明，在抗病毒治疗的情况下，从HBsAg阳性供体向HBsAg阳性受者进行肾移植是安全的。
