了解乙型肝炎核心阳性肝脏供体。

StephenW

Singapore Med J. 2018 Sep 5. doi: 10.11622/smedj.2018104. [Epub ahead of print]
Understanding the hepatitis B core positive liver donor.
Kwan KWC1, Lim TR1, Kumar R1, Krishnamoorthy TL1.
Author information

1
    Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.

Abstract

The increasing number of patients on the Singapore national liver transplant waiting list and the lack of donor livers have necessitated a review on the limited use of marginal donor liver grafts. Some grafts are of good quality but are considered marginal due to positive donor antibody to hepatitis B virus core protein serology, and negative hepatitis B surface antigen (HBsAg) and hepatitis B DNA. The fear is of viral reactivation during periods of intense immunosuppression. This is made possible by the ability of the hepatitis B virion to reside in a dormant state within the hepatocyte nucleus despite HBsAg clearance, i.e. the occult hepatitis B infection (OBI). In truth, appropriate selection of recipients and effective post-transplantation immunoprophylaxis significantly reduce the risk of hepatitis B viral reactivation. This article explains the confusion surrounding OBI and reviews current recommendations on how to manage such donor liver grafts.
KEYWORDS:

core positive donor; liver transplant; occult hepatitis B; viral reactivation

PMID:
    30182132
DOI:
    10.11622/smedj.2018104

StephenW

Singapore Med J. 2018 Sep 5. doi：10.11622 / smedj.2018104。 [提前打印]
了解乙型肝炎核心阳性肝脏供体。
Kwan KWC1，Lim TR1，Kumar R1，Krishnamoorthy TL1。
作者信息

1
    新加坡新加坡综合医院消化内科和肝病学系。

抽象

新加坡国家肝脏移植等候名单上的患者人数不断增加以及缺乏供体肝脏，因此需要对边缘供体肝脏移植物的有限使用情况进行审查。一些移植物具有良好的质量，但由于乙型肝炎病毒核心蛋白血清学的阳性供体抗体和乙型肝炎表面抗原阴性（HBsAg）和乙型肝炎DNA而被认为是边缘的。在强烈的免疫抑制期间，恐惧是病毒再激活。尽管HBsAg清除，即隐匿性乙型肝炎感染（OBI），但乙型肝炎病毒粒子在肝细胞核内处于休眠状态的能力使这成为可能。事实上，适当选择接受者和有效的移植后免疫预防可显着降低乙型肝炎病毒再激活的风险。本文解释了围绕OBI的混淆，并回顾了目前关于如何管理此类供体肝移植的建议。
关键词：

核心积极捐助者;肝移植;隐匿性乙型肝炎;病毒再激活

结论：
    30182132
DOI：
    10.11622 / smedj.2018104