在美国儿童接受肾脏移植从乙肝核心抗体阳性的供体

StephenW

Outcomes Among Children Who Received a Kidney Transplant in the United States From a Hepatitis B Core Antibody–Positive Donor, 1995–2010

    Rebecca L. Ruebner1, Taylor Moatz1, Sandra Amaral1,2, Peter P. Reese2,3, Emily A. Blumberg3, Jodi M. Smith4, Lara Danziger-Isakov5 and Benjamin L. Laskin1

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Author Affiliations

    1Division of Nephrology, Children's Hospital of Philadelphia
    2Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia
    3Department of Medicine, University of Pennsylvania, Philadelphia
    4Division of Nephrology, Seattle Children's Hospital, Washington
    5Department of Infectious Disease, Cincinnati Children's Hospital Medical Center, Ohio

    Corresponding Author: Benjamin L. Laskin, MD, MS, Children's Hospital of Philadelphia, 34th St and Civic Center Boulevard, Philadelphia, PA 19004. E-mail: [email protected].

    Received June 4, 2015.
    Accepted September 15, 2015.

Abstract

Background Accepting kidneys for transplant from donors with a history of hepatitis B virus infection may increase the availability of organs for those with end-stage kidney disease. In adult recipients, kidney transplants from hepatitis B virus core antibody–positive donors have resulted in favorable graft and patient survival rates. However, pediatric organ transplant recipients have developing immune systems and a higher risk of infectious complications than adults. Accordingly, little is known about the outcomes of children who have received a kidney transplant from a hepatitis B virus core antibody–positive donor.

Methods We included 11 898 children ≤18 years of age who received a first kidney transplant in the United States between January 1, 1995, and December 31, 2010, and who were recorded in the Scientific Registry of Transplant Recipients. We examined differences in graft and patient survival rates among children who received a kidney transplant from a hepatitis B virus core antibody–positive donor.

Results There were 199 children (1.7%) who received a kidney transplant from a hepatitis B virus core antibody–positive donor. More than 80% of these transplants occurred in recipients who were hepatitis B virus core antibody and surface antigen negative. After a median follow-up of 7.9 years, there were no significant differences in the adjusted graft (hazard ratio [HR], 1.03 [95% confidence interval (CI), 0.80–1.31]) or patient (HR, 1.12 [95% CI, 0.73–1.73]) survival rates according to donor core antibody status.

Conclusions It may be acceptable, on a case-by-case basis, to consider hepatitis B virus core antibody–positive donors for kidney transplants to seroprotected children with end-stage kidney disease.

StephenW

结果在儿童接受肾脏移植在美国从乙肝核心抗体阳性的供体，1995-2010

    丽贝卡L. Ruebner1，泰勒Moatz1，桑德拉Amaral1,2，彼得P. Reese2,3，艾米丽A. Blumberg3，乔迪M. Smith4，拉拉丹齐格-Isakov5和本杰明·L. Laskin1

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作者机构

    肾1区，儿童费城医院
    生物统计学和流行病学，宾夕法尼亚大学，费城教研室
    宾夕法尼亚州，费城大学3Department医学，
    肾内科，西雅图儿童医院，华盛顿4Division
    传染病，辛辛那提儿童医院医疗中心，俄亥俄州5Department

    通讯作者：本杰明·L. Laskin，MD，MS，费城，第34街和文娱中心大道，宾夕法尼亚州费城，19004.电子邮件儿童医院：[email protected]。

    收到2015年6月4日。
    接受2015年9月15日。

抽象的

背景接受肾脏移植捐赠者与乙肝病毒感染史可能会增加器官的可用性对于那些终末期肾脏疾病。在成人受者，乙肝病毒核心抗体阳性供体肾移植已造成有利的移植物和患者生存率。然而，儿科器官移植受者已经发育中的免疫系统和感染性并发症比成人更高的风险。因此，很少有人知道孩子是谁收到了肾移植手术从乙肝病毒核心抗体阳性捐助的结果。

方法我们包括11 898儿童≤18岁谁1995年1月1日和二〇一〇年十二月三十一日之间获得了第一笔肾移植在美国，谁被记录在移植受者科学登记年龄。我们研究谁接受了肾移植手术从乙肝病毒核心抗体阳性捐助儿童中的移植物和患者生存率的差异。

结果有199名儿童（1.7％），谁收到了肾移植手术从乙肝病毒核心抗体阳性的供体。超过80％的这些移植发生在谁是乙肝病毒核心抗体和表面抗原转阴的收件人。在平均随访7.9年，均在调整后移植物无显著差异（危险比[HR]，1.03 [95％可信区间（CI），0.80-1.31]）或患者（HR，1.12 [95％ CI，根据供体核心抗体状态0.73-1.73]）的存活率。

结论是可以接受的，对案件逐案的基础上，考虑乙肝病毒核心抗体阳性捐助者的肾脏移植到seroprotected儿童终末期肾脏疾病。