肝移植中乙型肝炎病毒核心抗体阳性移植物的安全性：中国

StephenW

World J Gastroenterol. 2018 Dec 28;24(48):5525-5536. doi: 10.3748/wjg.v24.i48.5525.
Safety of hepatitis B virus core antibody-positive grafts in liver transplantation: A single-center experience in China.
Lei M1, Yan LN2, Yang JY1, Wen TF1, Li B1, Wang WT1, Wu H1, Xu MQ1, Chen ZY1, Wei YG1.
Author information

1
    Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
2
    Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China. [email protected].

Abstract
BACKGROUND:

Given the shortage of suitable liver grafts for liver transplantation, proper use of hepatitis B core antibody-positive livers might be a possible way to enlarge the donor pool and to save patients with end-stage liver diseases. However, the safety of hepatitis B virus core antibody positive (HBcAb+) donors has been controversial. Initial studies were mainly conducted overseas with relatively small numbers of HBcAb+ liver recipients, and there are few relevant reports in the population of mainland China. We hypothesized that the safety of HBcAb+ liver grafts is not suboptimal.
AIM:

To evaluate the safety of using hepatitis B virus (HBV) core antibody-positive donors for liver transplantation in Chinese patients.
METHODS:

We conducted a retrospective study enrolling 1071 patients who underwent liver transplantation consecutively from 2005 to 2016 at West China Hospital Liver Transplantation Center. Given the imbalance in several baseline variables, propensity score matching was used, and the outcomes of all recipients were reviewed in this study.
RESULTS:

In the whole population, 230 patients received HBcAb+ and 841 patients received HBcAb negative (HBcAb-) liver grafts. The 1-, 3- and 5-year survival rates in patients and grafts between the two groups were similar (patient survival: 85.8% vs 87.2%, 77.4% vs 81.1%, 72.4% vs 76.7%, log-rank test, P = 0.16; graft survival: 83.2% vs 83.6%, 73.8% vs 75.9%, 70.8% vs 74.4%, log-rank test, P = 0.19). After propensity score matching, 210 pairs of patients were generated. The corresponding 1-, 3- and 5-year patient and graft survival rates showed no significant differences. Further studies illustrated that the post-transplant major complication rates and liver function recovery after surgery were also similar. In addition, multivariate regression analysis in the original cohort and propensity score-matched Cox analysis demonstrated that receiving HBcAb+ liver grafts was not a significant risk factor for long-term survival. These findings were consistent in both HBV surface antigen-positive (HBsAg+) and HBsAg negative (HBsAg-) patients.Newly diagnosed HBV infection had a relatively higher incidence in HBsAg- patients with HBcAb+ liver grafts (13.23%), in which HBV naive recipients suffered most (31.82%), although this difference did not affect patient and graft survival (P = 0.50 and P = 0.49, respectively). Recipients with a high HBV surface antibody (anti-HBs) titer (more than 100 IU/L) before transplantation and antiviral prophylaxis with nucleos(t)ide antiviral agents post-operation, such as nucleos(t)ide antiviral agents, had lower de novo HBV infection risks.
CONCLUSION:

HBcAb+ liver grafts do not affect the long-term outcome of the recipients. Combined with proper postoperative antiviral prophylaxis, utilization of HBcAb+ grafts is rational and feasible.
KEYWORDS:

Hepatitis B core antibody; Hepatitis B virus infection; Liver transplantation; Long-term outcome

PMID:
    30622380
PMCID:
    PMC6319134
DOI:
    10.3748/wjg.v24.i48.5525

StephenW

World J Gastroenterol。 2018年12月28日; 24（48）：5525-5536。 doi：10.3748 / wjg.v24.i48.5525。
肝移植中乙型肝炎病毒核心抗体阳性移植物的安全性：中国的单中心体验。
Lei M1，Yan LN2，Yang JY1，Wen TF1，Li B1，Wang WT1，Wu H1，Xu MQ1，Chen ZY1，Wei YG1。
作者信息

1
    四川大学华西医院肝移植中心肝外科，四川省成都市610041
2
    四川大学华西医院肝移植中心肝外科，四川省成都市610041 [email protected]。

抽象
背景：

鉴于缺乏合适的肝移植肝移植物，正确使用乙型肝炎核心抗体阳性肝脏可能是扩大供体库和挽救终末期肝病患者的可能途径。然而，乙型肝炎病毒核心抗体阳性（HBcAb +）供体的安全性一直存在争议。初步研究主要在海外进行，HBcAb +肝脏受者人数相对较少，而中国大陆人口的相关报道较少。我们假设HBcAb +肝脏移植物的安全性不是最理想的。
目标：

评估乙型肝炎病毒（HBV）核心抗体阳性供体在中国患者肝移植中的安全性。
方法：

我们进行了一项回顾性研究，招募了2005年至2016年在华西医院肝移植中心连续接受肝移植的1071例患者。鉴于若干基线变量的不平衡，使用了倾向评分匹配，并且在本研究中评估了所有接受者的结果。
结果：

在整个人群中，230名患者接受了HBcAb +，841名患者接受了HBcAb阴性（HBcAb-）肝移植。两组患者和移植物的1年，3年和5年生存率相似（患者存活率：85.8％vs 87.2％，77.4％vs 81.1％，72.4％vs 76.7％，log-rank test，P = 0.16;移植物存活率：83.2％对83.6％，73.8％对75.9％，70.8％对74.4％，对数秩检验，P = 0.19）。在倾向评分匹配后，产生210对患者。相应的1年，3年和5年患者和移植物存活率显示无显着差异。进一步研究表明，移植后主要并发症发生率和术后肝功能恢复情况也相似。此外，原始队列和倾向评分匹配的Cox分析的多变量回归分析表明，接受HBcAb +肝移植不是长期存活的重要风险因素。这些结果在HBV表面抗原阳性（HBsAg +）和HBsAg阴性（HBsAg-）患者中均一致。新诊断HBV感染的HBsAg患者HBcAb +肝移植的发生率相对较高（13.23％），其中HBV幼稚受者受影响最大（31.82％），尽管这种差异并不影响患者和移植物的存活率（分别为P = 0.50和P = 0.49）。移植前具有高HBV表面抗体（抗-HBs）滴度（超过100 IU / L）的接受者和术后核酸（t）ide抗病毒剂的抗病毒预防，如核苷（酸）抗病毒剂，具有较低的从头HBV感染风险。
结论：

HBcAb +肝脏移植物不影响接受者的长期结果。结合适当的术后抗病毒预防，HBcAb +移植物的使用是合理可行的。
关键词：

乙型肝炎核心抗体;乙型肝炎病毒感染;肝移植;长期结果

结论：
    30622380
PMCID：
    PMC6319134
DOI：
    10.3748 / wjg.v24.i48.5525

StephenW

https://www.wjgnet.com/1007-9327/full/v24/i48/5525.htm