Yu Songfeng, Cen Chao, Zhang Xuanyu, Cheng Longyu, Xia Weiliang, Jia Junjun, Ye Yufu, Yu Jun, Zhang Min, Shen Yan, Zheng Shusen
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
NHC Key Laboratory of Combined Multi-Organ Transplantation, Research Unit of Collaborative Diagnosis and Treatment For Hepatobiliary and Pancreatic Cancer, Chinese Academy of Medical Sciences, Hangzhou, China.
J Gastroenterol Hepatol. 2022 Jun;37(6):1052-1059. doi: 10.1111/jgh.15821. Epub 2022 Mar 23.
Donor shortage has become worldwide limitation in liver transplantation (LT). Use of hepatitis B virus surface antigen positive (HBsAg+) donors could be an alternative source of donor organs. This study aims to investigate the safety and efficacy of LT using HBsAg+ liver grafts and associated long-term outcome.
This was a retrospective study of adults LT registered in the database of the China Liver Transplant Registry between January 2015 and September 2018. By propensity score matching (1:1), 503 eligible patients who received HBsAg+ liver grafts were compared with 503 matched patients who received HBsAg- liver grafts.
The 1-, 3-, and 5-year patient survival rates were 81.52%, 72.04%, and 66.65% in HBsAg+ donor group, which were comparable with 83.93%, 77.27%, and 65.73% in HBsAg- donor group (P = 0.222). The 1-, 3-, and 5-year graft survival rates were also comparable between the two groups (81.49%, 71.45%, and 67.26% vs 83.62%, 77.11%, and 65.81%, respectively, P = 0.243). Most main complications were not increased in HBsAg+ donor group except for the retaining of HBsAg positivity after LT. Furthermore, transplanting HBsAg+ liver grafts did not result in inferior outcomes either in HBsAg+ or HBsAg- recipients. The risk of tumor recurrence after LT was not increased in hepatocellular carcinoma patients.
The outcomes of using HBsAg+ liver grafts were comparable with those of HBsAg- liver grafts. Our study provided strong evidence for the safe use of HBsAg+ grafts in LT to expand the donor liver pool.
供体短缺已成为全球肝移植（LT）的限制因素。使用乙型肝炎病毒表面抗原阳性（HBsAg+）供体可能是供体器官的替代来源。本研究旨在探讨使用HBsAg+肝脏移植物进行肝移植的安全性和有效性以及相关的长期预后。
这是一项对2015年1月至2018年9月在中国肝移植注册数据库中登记的成人肝移植进行的回顾性研究。通过倾向评分匹配（1:1），将503例接受HBsAg+肝脏移植物的合格患者与503例匹配的接受HBsAg-肝脏移植物的患者进行比较。
HBsAg+供体组的1年、3年和5年患者生存率分别为81.52%、72.04%和66.65%，与HBsAg-供体组的83.93%、77.27%和65.73%相当（P = 0.222）。两组的1年、3年和5年移植物生存率也相当（分别为81.49%、71.45%和67.26%对83.62%、77.11%和65.81%，P = 0.243）。除肝移植后HBsAg仍呈阳性外，HBsAg+供体组大多数主要并发症并未增加。此外，移植HBsAg+肝脏移植物在HBsAg+或HBsAg-受体中均未导致较差的预后。肝细胞癌患者肝移植后肿瘤复发风险并未增加。
使用HBsAg+肝脏移植物的预后与使用HBsAg-肝脏移植物的预后相当。我们的研究为在肝移植中安全使用HBsAg+移植物以扩大供肝库提供了有力证据。
