HBsAg阳性供肝和HBcAb阳性供肝在肝移植中的应用  

Utilization of liver grafts from hepatitis B surface antigen positive or anti-hepatitis B core positive donors

作　　者：姜涛[1] 卢实春[1] 赖威[1] 王孟龙[1] 刘源[1] 曾道炳[1] 李传云[1] 武聚山[1] 段斌炜[1] 王璐[1] 代传宙[1] 李宁[1] 

机构地区：[1]首都医科大学附属北京佑安医院肝胆外科暨肝移植中心,100069

出　　处：《中华器官移植杂志》2012年第4期200-204,共5页Chinese Journal of Organ Transplantation

基　　金：北京市卫生系统高层次卫生技术人才培养计划（2011-2-18）

摘　　要：目的探讨乙型肝炎表面抗原（HBsAg）阳性和乙型肝炎核心抗体（HBcAb）阳性供肝对肝移植受者近期乙型肝炎复发率和移植物及受者存活时间的影响。方法回顾分析2004年6月至2011年12月间单中心长期随访的387例肝移植受者的资料，其中HBsAg阳性供肝9例，HBcAb阳性供肝50例，乙型肝炎病毒（HBv）阴性供肝328例。采用乙型肝炎免疫球蛋白（HBIG）＋抗病毒药物的联合方案预防复发。比较3组受者术后近期HBV再感染（或移植肝HBV感染）及受者和移植肝存活情况。结果接受HBsAg阳性供肝者术后HBsAg持续为阳性。接受HBcAb阳性供肝者中，1例乙型肝炎再感染。接受HBV阴性供肝者中，5例出现HBsAg阳性（其中乙型肝炎病毒耐药复发2例，非乙型肝炎相关性疾病术后移植肝HBV感染3例）。接受HBsAg阳性供肝者的1、3、5年受者累积存活率为100％、86％和43％，接受HBcAb阳性供肝者的1、3、5年受者累积存活率为87％、79％和57％，接受HBV阴性供肝者的1、3、5年受者累积存活率为87％、80％和79％（Log-rank=1．287，P=0．525）。接受HBsAg阳性供肝者的1、3、5年移植物累积存活率为100％、86％和43％，接受H13cAb阳性供肝者的1、3、5年移植物累积存活率为85％、77％和56％，接受HBV阴性供肝者的1、3、5年移植物累积存活率为86％、79％和77％（Log-rank=1．288，P=0．525）。随访期内均未出现因乙型肝炎复发或HBV感染所致的移植肝功能丧失和受者死亡。结论在采取有效的抗病毒治疗措施的情况下，HBcAb阳性供肝对移植物及受者存活时间无明显影响。对于危重患者，可以考虑采用HBsAg阳性供肝的肝移植。Objective To evaluate the influence of hepatitis B surface antigen positive or antihepatitis B core positive donors on HBV allograft re-infection or de novo hepatitis B and recipients and grafts survival after liver transplantation. Methods Between June 2004 and December 2011, 510 liver transplants were performed at our department while 387 patients were followed up. Among them, 9 patients received hepatitis B surface antigen positive grafts, 50 patients received anti-hepatitis B core positive grafts, and 328 patients received HBV marks negative grafts. The rate of HBV allograft reinfection or de novo hepatitis B and accumulative recipients as well as grafts survival were compared. Results All recipients with hepatitis B surface antigen positive donors remained hepatitis B surface antigen carriers after operation. HBV allograft re-infection occurred in one recipient of anti-hepatitis B core positive donor group. Five recipients with HBV marks negative donors appeared hepatitis B surface antigen positive, including two cases of Lamivudine resistance leading to HBV allograft reinfection and three cases of de novo hepatitis B from non-related diseases. The 1-, 3-, 5-year accumulative survival rate in anti-hepatitis B core positive grafts group, hepatitis B surface antigen positive grafts group and HBV marks negative grafts group was 100%, 86%, 43%）.87%, 790%, 57%; and 87%, 80%, 79%, respectively （Log-rank = 1. 287, P = 0. 525）. And the 1-, 3-, 5-year accumulative grafts survival rate in these three groups was 100%, 86%, 43%% 85%, 77%, 56%% and 86%/00, 79%, 770/oo, respectively （Log-rank= 1. 288,P= 0. 525）. During the follow-up period, no graft loss or death was found to be related to the HBV allograft reinfection or de novo hepatitis B. Conclusion Liver grafts from anti-hepatitis B core positive donors do not increase the risk of graft loss or recipient death due to HBV allograft re-infection or de novo hepatitis B under effective antiviral therapy. Hepatitis B surface antigen positive donors are feasible

关 键 词：肝移植 组织供者 肝炎表面抗原 乙型 肝炎核心抗体 乙型 

分 类 号：R512.62[医药卫生—内科学]