Cui Yufeng, Lu Wei, Gao Wei, Dong Chong, Han Chao, Liu Yihe
First Center Clinical College of Tianjin Medical University, Tianjin 300192, China (Cui YF); Tianjin Institute of Hepatology, Tianjin First Center Hospital, Tianjin 300192, China (Lu W); Department of Transplant Surgery, Tianjin First Center Hospital, Tianjin 300192, China (Gao W, Dong C, Han C); Department of Transplant Intensive Care Unit, Tianjin First Center Hospital, Tianjin 300192, China (Liu YH). Corresponding author: Lu Wei, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017 Oct;29(10):926-930. doi: 10.3760/cma.j.issn.2095-4352.2017.10.013.
To investigate the effect of active immunization on prevention of post-transplantation de novo hepatitis B virus (HBV) infection in patients receiving liver grafts from hepatitis B core antibody (HBcAb) positive donors.
A retrospective analysis was conducted. Eighty-seven children undergoing liver transplantation from HBcAb positive donors admitted to Tianjin First Center Hospital from October 2012 to December 2016 were enrolled, and the data of donors and recipients were collected. The hepatitis B vaccine was given before operation for hepatitis B surface antibody (HBsAb) > 1 000 U/L; hepatitis B immunoglobulin (HBIG) 100 U/kg was given during the operation, in order to prevent children from HBV infected by obtaining passive immunity quickly, children with HBsAb < 200 U/L after operation were injected with hepatitis B vaccine for booster immunization. HBV markers and liver function of recipients were determined before liver transplantation and during the follow-up, which up to April 2017. According to the children got de novo HBV infection after operation or not, the preventive effect of active immunization before and after transplantation operation on HBV infection was analyzed and compared.
In 87 children who received HBcAb positive donor livers, 9 (10.3%) developed de novo HBV infection, which occurred in 16 (10, 25) months after liver transplantation. Among the 9 children with HBV infection, 7 children had HBsAb < 1 000 U/L before the operation, the ratio was statistically increased as compared with the children without HBV infection [77.8% (7/9) vs. 37.2% (29/78), P < 0.05]. After the transplantation, 62 children of 78 without HBV infection showed a good response to hepatitis B vaccination, 1 child after inoculation of hepatitis B vaccine, the titer of HBsAb was still less than 200 U/L, 15 children without administration of hepatitis B vaccine, only with HBIG injection for prevention. The HBsAb of children with de nove HBV infection were less than 200 U/L after operation, the ratio was significantly increased as compared with children without HBV infection [100.0% (9/9) vs. 20.5% (16/78), P < 0.01].
The establishment of active immunization method can effectively prevent children with de novo HBV infection occurred in pediatric recipients from HBcAb positive donors with preventive treatment.
探讨主动免疫对预防接受乙型肝炎核心抗体（HBcAb）阳性供体肝脏移植患者术后新发乙型肝炎病毒（HBV）感染的效果。
进行回顾性分析。纳入2012年10月至2016年12月在天津市第一中心医院接受HBcAb阳性供体肝脏移植的87例儿童，收集供体和受体资料。术前对于乙型肝炎表面抗体（HBsAb）>1 000 U/L者给予乙肝疫苗；术中给予乙肝免疫球蛋白（HBIG）100 U/kg，为使儿童快速获得被动免疫以预防HBV感染，术后HBsAb<200 U/L者注射乙肝疫苗进行加强免疫。于肝移植术前及随访期间（截至2017年4月）测定受体的HBV标志物及肝功能。根据术后是否发生新发HBV感染，分析比较移植手术前后主动免疫对HBV感染的预防效果。
87例接受HBcAb阳性供体肝脏的儿童中，9例（10.3%）发生新发HBV感染，发生于肝移植后16（10，25）个月。9例HBV感染儿童中，7例术前HBsAb<1 000 U/L，该比例与未发生HBV感染的儿童相比差异有统计学意义[77.8%（7/9）比37.2%（29/78），P<0.05]。移植后，78例未发生HBV感染的儿童中62例对乙肝疫苗接种反应良好，1例接种乙肝疫苗后HBsAb滴度仍<200 U/L，15例未接种乙肝疫苗，仅注射HBIG预防。发生新发HBV感染的儿童术后HBsAb<200 U/L，该比例与未发生HBV感染的儿童相比显著升高[100.0%（9/9）比20.5%（16/78），P<0.01]。
建立的主动免疫方法可有效预防接受HBcAb阳性供体肝移植的儿童受体发生新发HBV感染。
