成功的肾移植:从表面抗原阳性捐赠者至抗原阴性的接受者

StephenW

http://www.docguide.com/successful-kidney-transplantation-hepatitis-b-surface-antigen-positive-donor-antigen-negative-recipi?hash=c8431e6c&eid=30097&alrhash=2f4244-e14fac0ff7ef1d5b0c78458126191858
Source: Am J Kidney Dis  |  Posted 5 days ago
Successful Kidney Transplantation From a Hepatitis B Surface Antigen-Positive Donor to an Antigen-Negative Recipient Using a Novel Vaccination Regimen;
成功的肾移植B型肝炎表面抗原阳性供体抗原阴性的接受者使用一种新的疫苗接种方案;

Singh G, Hsia-Lin A, Skiest D, Germain M, O'Shea M, Braden G; American Journal of Kidney Diseases (Dec 2012)

   
Transplanting a kidney from a hepatitis B surface antigen (HBsAg)-positive donor to an HBsAg-negative recipient who is naturally immune has been successful in countries endemic for hepatitis B virus (HBV). However, in most of these cases, the donors were deceased. We present a report of a successful HBsAg-discordant kidney transplantation in the United States; in this case, a living donor kidney was transplanted to a vaccinated recipient. The wife of a 58-year-old HBsAg-negative man volunteered to donate a kidney to her husband. She had chronic hepatitis B but undetectable HBV DNA. She tested positive for HBsAg and antibody to hepatitis B core antigen, but hepatitis B e antigen was undetectable. The recipient failed to develop an antibody response to 3 doses of intramuscular recombinant HBV vaccine given in consecutive months. Immunity was induced by using biweekly intradermal vaccine. However, antibody titer tapered to<10 mIU/mL over 14 months. An intramuscular booster vaccine resulted in a prolonged anamnestic response, allowing for successful living unrelated donor transplantation. During the 10 years since transplantation, the patient has continued to have normal liver function, with undetectable HBsAg and HBV DNA. Antibody titers to HBsAg slowly decreased to 5.8 mIU/mL during the 10 years. Transplant function has been well preserved. This approach to inducing long-term immunity for transplantation merits further study in the United States.

StephenW

B型肝炎表面抗原（HBsAg）阳性供体的HBsAg阴性的
接受人是自然免疫的B型肝炎病毒（HBV）流行国家已成功移植的肾脏。然而，在大多数情况下，捐助者死亡。我们提交一份报告，一个成功的乙肝表面抗原不一致的肾移植在美国，在这种情况下，活体肾移植接种疫苗的
接受人。一个58岁的HBsAg阴性的男子的妻子自愿捐肾给她的丈夫。她患有慢性B型肝炎，但检测不到HBV DNA。她乙肝表面抗原和乙肝核心抗原抗体检测呈阳性，但B型肝炎e抗原检测不到。的
接受人没有发展的抗体反应，3个剂量肌注重组乙肝疫苗在连续三个月。通过使用双周皮内注射疫苗的免疫诱导。然而，抗体效价逐渐减量至<10 mIU / mL的超过14个月。肌肉注射助推器疫苗导致在长时间的回忆反应，从而为成功的活体非亲属供体移植。的患者在移植的10年以来，不断有肝功能正常，HBsAg和HBV DNA检测不到。的10年间，对HBsAg的抗体滴度逐渐下降到5.8 mIU / mL的。移植功能得到了很好的保留。这种方法诱导长期免疫移植值得进一步研究在美国。