乙型肝炎表面抗原阳性移植物在死亡的肝移植中的病毒活性

StephenW

J Viral Hepat. 2018 Feb 12. doi: 10.1111/jvh.12880. [Epub ahead of print]
Viral activity and outcome of hepatitis B surface antigen-positive grafts in deceased liver transplantation.Lee WC1, Chou HS1, Lee CS2, Wu TH1, Wang YC1, Cheng CH1, Lee CF1, Wu TJ1, Chan KM1.
Author information
1Departments of Liver and Transplantation Surgery and Chang, Gung University College of Medicine, Taoyuan, Taiwan.2Hepatology, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan.

AbstractIndications of liver transplantation are extensive, but deceased donation does not meet the demand. Hepatitis B surface antigen (HBs Ag)-positive grafts used to be discarded in the past. The aim of this study is to examine viral activity and outcome of HBsAg-positive deceased grafts transplanted to HBsAg-positive recipients. Eleven HBsAg-positive deceased grafts were transplanted to HBsAg-positive patients with acute liver failure (3 patients), hepatocellular carcinoma (6 patients) and repeatedly bleeding varices (2 patients). Postoperatively, hepatitis B virus (HBV) infection was treated by a combination of anti-viral nucleoside and nucleotide analogues. HBV DNA and HBsAg were measured periodically. The median (interquartile) model of end stage liver disease score for the recipients was 19 (16-32) with a range from 11 to 40. HBV DNA was detected in 6 patients with a range from 61 to 1083 IU/ml before transplantation. After transplantation, HBV DNA was detected in 4 patients in the first month, 2 patients in the 6th month and became undetectable for all patients at end of the first year. The quantitative HBsAg ranged from 0.86 to 241.1IU/ml at 6 months and 0.34 to 238.5U/ml at 24 months (p = 0.135). Three of the patients died in the early phase and the other patients were followed up for 40.0±19.2 months with normal liver function. In conclusion, HBsAg-positive deceased liver grafts function well with minimal viral activity under treatment of combined anti-viral nucleoside and nucleotide analogues. Use of HBsAg-positive deceased grafts is feasible and increases the donor pool to rescue dying patients. This article is protected by copyright. All rights reserved.


PMID:29431877DOI:10.1111/jvh.12880

StephenW

J Viral Hepat。 2018年2月12日。doi：10.1111 / jvh.12880。 [电子版提前打印]
乙型肝炎表面抗原阳性移植物在死亡的肝移植中的病毒活性和结果。
Lee WC1，Chou HS1，Lee CS2，Wu TH1，Wang YC1，Cheng CH1，Lee CF1，Wu TJ1，Chan KM1。
作者信息

1
    肝移植外科和台湾桃园Chang Gung University医学院。
2
    台湾桃园长庚大学医学院长庚医院肝脏科。

抽象

肝移植的适应证很广泛，但死亡的捐献并不能满足需求。乙型肝炎表面抗原（HBsAg）阳性移植物过去曾被丢弃。这项研究的目的是检查移植到HBsAg阳性接受者的HBsAg阳性已死亡移植物的病毒活性和结果。将11例HBsAg阳性已死亡的移植物移植到患有急性肝衰竭（3名患者），肝细胞癌（6名患者）和反复出血静脉曲张（2名患者）的HBsAg阳性患者。术后，乙型肝炎病毒（HBV）感染通过抗病毒核苷和核苷酸类似物的组合来治疗。定期测量HBV DNA和HBsAg。受体患者的末期肝病评分中位数（四分位数）为19（16-32），范围为11至40.在移植前6名患者中检测到HBV DNA，范围为61至1083 IU / ml。移植后，第一个月检测到4例患者HBV DNA，第6个月检测到2例患者，第一年末检测不到所有患者HBV DNA。定量HBsAg在6个月时为0.86至241.1IU / ml，24个月时为0.34至238.5U / ml（p = 0.135）。其中3例患者在早期死亡，其他患者随访40.0±19.2个月，肝功能正常。总之，在联合抗病毒核苷和核苷酸类似物的治疗下，HBsAg阳性已死的肝脏移植物功能良好，病毒活性最低。使用HBsAg阳性已死亡的移植物是可行的，并增加供体池以拯救垂死的患者。本文受版权保护。版权所有。

结论：
    29431877
DOI：
    10.1111 / jvh.12880