Chen Zhitao, Ma Yihao, Dong Yuqi, Chen Chuanbao, Wang Hanyu, Wang Tielong, Yu Jia, Hong Xitao, Chen Maogen, He Xiaoshun, Ju Weiqiang
Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Grangdong, People's Republic of China.
Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, Guangdong, People's Republic of China.
PeerJ. 2023 Jul 26;11:e15620. doi: 10.7717/peerj.15620. eCollection 2023.
The use of extended criteria donor (ECD) grafts such as donor with infection of hepatitis B virus (HBV) is a potential solution for organ shortage. In this study, we aimed to evaluate the safety and long-term survival of utilization of hepatitis B surface antigen-positive (HBsAg+) donor livers in HCC patients using propensity score matching (PSM) analysis.
Forty-eight donors with HBsAg-positive and 279 donors with HBsAg-negative were transplanted and enrolled in this study. PSM analysis were used to eliminate selection bias. Perioperative data and survival were collected and analyzed.
PSM generated 44 patient pairs. When comparing intra- and post-operative data, no significant difference was found between groups ( > 0.05). Patients with a HBsAg-positive donor had significantly worse progression-free survival (1-year: 65.9% vs. 90.9%; 3-year: 18.1% vs. 70.4%, = 0.0060) and overall survival (1-year: 84.1% and 95.4%; 3-year: 27.2% vs. 79.5%, = 0.0039). In multivariate analysis, donor HBsAg-positivity was an independent risk factor for survival and occurrence ( = 0.005 and 0.025, respectively).
In conclusion, with adequate antiviral prophylaxis and treatment, utilization of HBsAg positive liver grafts did not increase the incidence of early-stage complications. However, patient with an HBsAg-positive graft had poorer progression-free survival and overall survival.
使用诸如感染乙型肝炎病毒（HBV）的供体等扩大标准供体（ECD）移植物是解决器官短缺问题的一种潜在方法。在本研究中，我们旨在通过倾向评分匹配（PSM）分析评估在肝癌患者中使用乙型肝炎表面抗原阳性（HBsAg+）供体肝脏的安全性和长期生存率。
48例HBsAg阳性供体和279例HBsAg阴性供体进行了肝移植并纳入本研究。采用PSM分析以消除选择偏倚。收集并分析围手术期数据和生存率。
PSM产生了44对患者。比较术中和术后数据时，两组之间未发现显著差异（>0.05）。接受HBsAg阳性供体的患者无进展生存期明显更差（1年：65.9%对90.9%；3年：18.1%对70.4%，=0.0060），总生存期也明显更差（1年：84.1%对95.4%；3年：27.2%对79.5%，=0.0039）。多因素分析中，供体HBsAg阳性是生存和复发的独立危险因素（分别为=0.005和0.025）。
总之，在进行充分的抗病毒预防和治疗的情况下，使用HBsAg阳性肝移植物并未增加早期并发症的发生率。然而，接受HBsAg阳性移植物的患者无进展生存期和总生存期较差。
