Anwar Nadeem, Sherman Kenneth E
University of Cincinnati College of Medicine, Cincinnati, Ohio.
J Viral Hepat. 2018 Oct;25(10):1110-1115. doi: 10.1111/jvh.12962. Epub 2018 Aug 14.
Liver transplant centres throughout the USA face a huge shortage of liver organs for their wait-listed patients. Various types of innovations are being considered for expansion of this donor pool. Organs that were previously deemed to be high risk are now being considered for transplantation. For the last 25 years, hepatitis B core antibody (anti-HBc+) organs have been used for liver transplantation. While the initial transplantations did reveal a high incidence of de novo hepatitis (DNH) in the recipients, the medical knowledge and experience have evolved and this risk has been markedly decreased. In this paper, medical literature evaluating the safety of such organ transplants has been reviewed. There is strong evidence to suggest that using anti-HBc+ organs with appropriate prophylaxis after transplant is a safe practice with good patient and graft survivals. In the second half of the paper, we discuss whether it is ethical to use anti-HBc+ organs. We argue that the use of such organs is in compliance with the principles of medical ethics and that society at large benefits from the use of these organs. Hence, we recommend that the use of such organs is both safe and ethical and this practice should be continued in the future.
美国各地的肝移植中心面临着为其等待名单上的患者提供肝脏器官的严重短缺。人们正在考虑各种创新方法来扩大这个供体库。以前被认为是高风险的器官现在正被考虑用于移植。在过去25年里，乙肝核心抗体阳性（抗-HBc+）的器官已被用于肝移植。虽然最初的移植确实显示受者中发生新发肝炎（DNH）的发生率很高，但医学知识和经验已经发展，这种风险已显著降低。在本文中，对评估此类器官移植安全性的医学文献进行了综述。有强有力的证据表明，在移植后使用抗-HBc+器官并采取适当的预防措施是一种安全的做法，患者和移植物的存活率都很高。在本文的后半部分，我们讨论使用抗-HBc+器官是否符合伦理。我们认为，使用此类器官符合医学伦理原则，而且整个社会都能从这些器官的使用中受益。因此，我们建议使用此类器官既安全又符合伦理，这种做法在未来应该继续下去。
