从HBsAg +活体供体到HBsAg受体的肾脏移植：在中国高容量中心

StephenW

Clin Infect Dis. 2020 Feb 26. pii: ciaa178. doi: 10.1093/cid/ciaa178. [Epub ahead of print]
Kidney Transplantation from HBsAg+ Living Donors to HBsAg- Recipients: Clinical Outcomes at a High-volume Center in China.
Wang XD1,2, Liu JP1,2, Song TR1,2, Huang ZL1,2, Fan Y1,2, Shi YY3, Chen LY4, Lv YH5, Xu ZL5, Li XH6, Wang L1,2, Lin T1,2.
Author information

1
    Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
2
    Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
3
    Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
4
    Department of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
5
    West China School of Clinical Medicine, Sichuan University, Chengdu, Sichuan, China.
6
    Department of Health Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China.

Abstract
BACKGROUND:

Data on kidney transplantation (KTx) from hepatitis B surface antigen (HBsAg)+ donors to HBsAg- recipients [D(HBsAg+)/R(HBsAg-)] are limited. We aimed to report the outcomes of D(HBsAg+)/R(HBsAg-) KTx in recipients with or without hepatitis B surface antibody (HBsAb).
METHODS:

Eighty-three D(HBsAg+)/R(HBsAg-) living KTx cases were retrospectively identified. The 384 cases of KTx from hepatitis B core antibody (HBcAb)+ living donors to HBcAb- recipients [D(HBcAb+)/R(HBcAb-)] were used as the control group. Primary endpoint was post-transplant HBsAg -→+.
RESULTS:

Before KTx, 24 donors (28.9%) in the D(HBsAg+)/R(HBsAg-) group were hepatitis B virus (HBV) DNA+, and 20 recipients were HBsAb-. All eighty-three D(HBsAg+)/R(HBsAg-) recipients received HBV prophylaxis, while no D(HBcAb+)/R(HBcAb-) recipients received prophylaxis. After a median follow-up of 36 months (range 6-106) and 36 months (range 4-107) for the D(HBsAg+)/R(HBsAg-) and D(HBcAb+)/R(HBcAb-) groups, respectively, 2/83 (2.41%) D(HBsAg+)/R(HBsAg-) recipients and 1/384 (0.26%) D(HBcAb+)/R(HBcAb-) became HBsAg+, accompanied with HBV DNA+ (P=0.083). The three recipients with HBsAg-→+ were exclusively HBsAb-/HBcAb- before KTx. Recipient deaths were more frequent in the D(HBsAg+)/R(HBsAg-) group (6.02% vs. 1.04%, P=0.011), while liver and graft function, rejection, infection, and graft loss were not significantly different. In univariate analyses, pre-transplant HBsAb-/HBcAb- combination in the D(HBsAg+)/R(HBsAg-) recipients carried a significantly higher risk of HBsAg-→+, HBV DNA-→+, and death.
CONCLUSIONS:

Living D(HBsAg+)/R(HBsAg-) KTx in HBsAb+ recipients provides excellent graft and patient survivals without HBV transmission. HBV transmission risks should be more balanced with respect to benefits of D(HBsAg+)/R(HBsAg-) KTx in HBsAb-/HBcAb- candidates.

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].
KEYWORDS:

Donor-derived HBV transmission; HBsAg+ living donors; HBsAg- recipients; Kidney transplantation

PMID:
    32100025
DOI:
    10.1093/cid/ciaa178

StephenW

临床感染病。 2020年2月26日。pii：ciaa178。 Doi：10.1093 / cid / ciaa178。 [Epub提前发行]
从HBsAg +活体供体到HBsAg受体的肾脏移植：在中国高容量中心的临床结果。
Wang XD1,2，Liu JP1,2，Song TR1,2，Huang ZL1,2，Fan Y1,2，Shi YY3，Chen LY4，Lv YH5，Xu ZL5，Li XH6，Wang L1,2，Lin T1,2。
作者信息

1个
四川大学华西医院泌尿外科/泌尿外科研究所，四川成都
2
四川大学华西医院器官移植中心，四川成都
3
四川大学华西医院肾内科，四川成都
4
四川大学华西医院感染科，四川成都
5
四川大学华西临床医学院，四川成都。
6
四川大学华西公共卫生学院卫生统计系，四川成都。

抽象
背景：

从乙肝表面抗原（HBsAg）+供体到HBsAg受体的肾脏移植（KTx）数据[D（HBsAg +）/ R（HBsAg-）]是有限的。我们旨在报告接受或不接受乙肝表面抗体（HBsAb）的接受者的D（HBsAg +）/ R（HBsAg-）KTx结果。
方法：

回顾性鉴定了83例D（HBsAg +）/ R（HBsAg-）活KTx病例。以384例由乙型肝炎核心抗体（HBcAb）+活供者向HBcAb受体[D（HBcAb +）/ R（HBcAb-）]的KTx患者为对照组。主要终点为移植后HBsAg→→。
结果：

在进行KTx之前，D（HBsAg +）/ R（HBsAg-）组中的24位捐赠者（28.9％）为乙型肝炎病毒（HBV）DNA +，而20位接受者为HBsAb-。八十三名D（HBsAg +）/ R（HBsAg-）接受者均接受了HBV预防，而D（HBcAb +）/ R（HBcAb-）接受者均未接受预防。 D（HBsAg +）/ R（HBsAg-）和D（HBcAb +）/ R（HBcAb-）组的中位随访36个月（范围6-106）和36个月（范围4-107）分别有2/83（2.41％）D（HBsAg +）/ R（HBsAg-）受者和1/384（0.26％）D（HBcAb +）/ R（HBcAb-）受者成为HBsAg +，并伴有HBV DNA + （P ＝ 0.083）。在接受KTx之前，三名HBsAg-→+的接受者仅是HBsAb- / HBcAb-。 D（HBsAg +）/ R（HBsAg-）组的接受者死亡更为频繁（6.02％vs. 1.04％，P = 0.011），而肝脏和移植物功能，排斥，感染和移植物损失没有显着差异。在单因素分析中，D（HBsAg +）/ R（HBsAg-）接受者的移植前HBsAb- / HBcAb-组合携带HBsAg-→+，HBV DNA-→+以及死亡的风险明显更高。
结论：

HBsAb +受者的活体D（HBsAg +）/ R（HBsAg-）KTx可提供出色的移植物和患者存活率，而不会传播HBV。关于HBsAb-/ HBcAb-候选者中D（HBsAg +）/ R（HBsAg-）KTx的益处，HBV传播风险应更加平衡。

©2020作者。牛津大学出版社，美国传染病学会。版权所有。有关权限，请发送电子邮件至：[email protected]。
关键字：

供体来源的HBV传播； HBsAg +活体供体； HBsAg受体；肾脏移植

PMID：
32100025
DOI：
10.1093 / CID / CIAA178