Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
World J Gastroenterol. 2018 Dec 28;24(48):5525-5536. doi: 10.3748/wjg.v24.i48.5525.
Given the shortage of suitable liver grafts for liver transplantation, proper use of hepatitis B core antibody-positive livers might be a possible way to enlarge the donor pool and to save patients with end-stage liver diseases. However, the safety of hepatitis B virus core antibody positive (HBcAb) donors has been controversial. Initial studies were mainly conducted overseas with relatively small numbers of HBcAb liver recipients, and there are few relevant reports in the population of mainland China. We hypothesized that the safety of HBcAb liver grafts is not suboptimal.
To evaluate the safety of using hepatitis B virus (HBV) core antibody-positive donors for liver transplantation in Chinese patients.
We conducted a retrospective study enrolling 1071 patients who underwent liver transplantation consecutively from 2005 to 2016 at West China Hospital Liver Transplantation Center. Given the imbalance in several baseline variables, propensity score matching was used, and the outcomes of all recipients were reviewed in this study.
In the whole population, 230 patients received HBcAb and 841 patients received HBcAb negative (HBcAb) liver grafts. The 1-, 3- and 5-year survival rates in patients and grafts between the two groups were similar (patient survival: 85.8% 87.2%, 77.4% 81.1%, 72.4% 76.7%, log-rank test, = 0.16; graft survival: 83.2% 83.6%, 73.8% 75.9%, 70.8% 74.4%, log-rank test, = 0.19). After propensity score matching, 210 pairs of patients were generated. The corresponding 1-, 3- and 5-year patient and graft survival rates showed no significant differences. Further studies illustrated that the post-transplant major complication rates and liver function recovery after surgery were also similar. In addition, multivariate regression analysis in the original cohort and propensity score-matched Cox analysis demonstrated that receiving HBcAb liver grafts was not a significant risk factor for long-term survival. These findings were consistent in both HBV surface antigen-positive (HBsAg) and HBsAg negative (HBsAg) patients.Newly diagnosed HBV infection had a relatively higher incidence in HBsAg patients with HBcAb liver grafts (13.23%), in which HBV naive recipients suffered most (31.82%), although this difference did not affect patient and graft survival ( = 0.50 and = 0.49, respectively). Recipients with a high HBV surface antibody (anti-HBs) titer (more than 100 IU/L) before transplantation and antiviral prophylaxis with nucleos(t)ide antiviral agents post-operation, such as nucleos(t)ide antiviral agents, had lower HBV infection risks.
HBcAb liver grafts do not affect the long-term outcome of the recipients. Combined with proper postoperative antiviral prophylaxis, utilization of HBcAb grafts is rational and feasible.
由于适合进行肝移植的肝脏供体短缺，合理利用乙型肝炎核心抗体阳性（HBcAb）的肝脏可能是扩大供体库并拯救终末期肝病患者的一种可行方法。然而，HBcAb 供体的安全性一直存在争议。最初的研究主要是在海外进行的，HBcAb 肝受者数量相对较少，而在中国大陆人群中几乎没有相关报道。我们假设 HBcAb 肝移植物的安全性并非不理想。
评估乙型肝炎病毒（HBV）核心抗体阳性供体用于中国患者肝移植的安全性。
我们进行了一项回顾性研究，纳入了 2005 年至 2016 年在华西医院肝脏移植中心连续接受肝移植的 1071 例患者。由于基线变量存在不平衡，因此使用了倾向评分匹配，并对所有受者的结局进行了回顾性研究。
在全人群中，230 例患者接受了 HBcAb 阳性肝移植物，841 例患者接受了 HBcAb 阴性（HBcAb）肝移植物。两组患者和移植物的 1、3 和 5 年生存率相似（患者生存率：85.8% 87.2%，77.4% 81.1%，72.4% 76.7%，log-rank 检验， = 0.16；移植物生存率：83.2% 83.6%，73.8% 75.9%，70.8% 74.4%，log-rank 检验， = 0.19）。在进行倾向评分匹配后，生成了 210 对患者。相应的 1、3 和 5 年患者和移植物生存率无显著差异。进一步的研究表明，术后主要并发症发生率和肝功能恢复也相似。此外，原始队列中的多变量回归分析和倾向评分匹配 Cox 分析表明，接受 HBcAb 肝移植物不是长期生存的显著危险因素。这些发现在 HBV 表面抗原阳性（HBsAg）和 HBsAg 阴性（HBsAg）患者中均一致。在 HBsAg 患者中，HBcAb 肝移植物的新诊断乙型肝炎病毒感染发生率相对较高（13.23%），其中乙型肝炎病毒初治受者受影响最大（31.82%），尽管这一差异并未影响患者和移植物的生存率（ = 0.50 和 = 0.49）。在移植前具有高乙型肝炎表面抗体（抗-HBs）滴度（>100 IU/L）和术后使用核苷（酸）类似物抗病毒药物（如核苷（酸）类似物）进行抗病毒预防的受者，HBV 感染风险较低。
HBcAb 肝移植物不影响受者的长期预后。结合适当的术后抗病毒预防，合理使用 HBcAb 移植物是可行的。
