http://www.sciencedirect.com/science/article/pii/S0168827811007835
Research Article
Liver transplantation from hepatitis B surface antigen positive donors: A safe way to expand the donor pool- Elisabetta Loggi1,
- Lorenzo Micco1,
- Giorgio Ercolani2,
- Alessandro Cucchetti2,
- Florian K. Bihl3, 4,
- Gian Luca Grazi5,
- Stefano Gitto1,
- Andrea Bontadini6,
- Mauro Bernardi1,
- Paolo Grossi7, 8,
- Alessandro Nanni Costa8,
- Antonio Daniele Pinna2,
- Christian Brander9, 10,
- Pietro Andreone1,
 , 
- 1 Department of Clinical Medicine, University of Bologna, Bologna, Italy
- 2 Multiorgan Transplant Unit, Sant’Orsola-Malpighi Hospital, Bologna, Italy
- 3 Gastrointestinal and Hepatology Unit, Bellinzona Hospital, Bellinzona, Switzerland
- 4 Gastrointestinal and Hepatology Unit, University Hospital Geneva, Geneva, Switzerland
- 5 Surgery Unit, Regina Elena Institute, Rome, Italy
- 6 Transfusion Service, Sant’Orsola-Malpighi Hospital, Bologna, Italy
- 7 Infectious and Tropical Diseases Unit, Department of Transplantation, University of Insumbria, Varese, Italy
- 8 National Transplant Centre, Istituto Superiore di Sanità, Rome, Italy
- 9 AIDS Research Institute IrsiCaixa – HIVACAT, Germans Trias i Pujol Hospital, Badalona, Barcelona, Spain
- 10 Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
- Received 10 May 2011. Revised 1 September 2011. Accepted 27 September 2011. Available online 22 October 2011.
Background & AimsThe main limitation of orthotopic liver transplantation (OLT) is the scarcity of available donor organs. A possibility to increase the organ pool is to use grafts from hepatitis B virus surface antigen (HBsAg) positive donors, but few data are currently available in this setting. We assessed the clinical, serovirological, and immunological outcomes of liver transplant from HBsAg positive donors in a single centre study. MethodsFrom 2005 to 2009 10 patients underwent OLT from HBsAg positive donors, for HBV-related disease (n = 6) or HBV-unrelated disease (n = 4). The median follow-up was 42 months (range 12–60). All recipients were HBcAb positive and were given antiviral prophylaxis. ResultsPatients transplanted for HBV-related disease never cleared HBsAg. Two HBsAg negative patients never tested positive for HBsAg, whereas the others experienced an HBsAg appearance, followed by spontaneous production of anti-HBs, allowing HBsAg clearance. No patient ever had any sign of HBV hepatitis. HBV replication was effectively controlled by antiviral therapy. The immunologic sub-study showed that a most robust anti-HBV specific T cell response was associated with the control of HBV infection. ConclusionsOLT from HBsAg positive donors seems to be a safe procedure in the era of highly effective antiviral therapy.
Abbreviations- OLT, orthotopic liver transplantation;
- ESLD, end-stage liver disease;
- HCC, hepatocellular carcinoma;
- HBV, hepatitis B virus;
- HBsAg, hepatitis B surface antigen;
- CNT, National Transplant Centre;
- HBcAb, hepatitis B core antibody;
- HDV, hepatitis delta virus;
- HCV, hepatitis C virus;
- MELD, model for end stage liver disease;
- HBIg, hepatitis B virus-specific immunoglobulins;
- LMV, lamivudine;
- anti-HBs, hepatitis B surface antibody;
- HBeAg, hepatitis B e antigen;
- CMIA, Chemiluminescent Microparticle Immunoassay;
- PCR, polymerase chain reaction;
- PBMCs, peripheral blood mononuclear cells;
- IFN-γ, interferon-gamma;
- HLA, human leucocyte antigen system;
- ADV, adefovir dipivoxil;
- TDF, tenofovir
Keywords- Liver transplantation;
- Hepatitis B surface antigen-positive donor;
- Hepatitis B virus (HBV);
- Marginal graft;
- Immune response
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发表于 2012-2-17 17:51
