肾脏从乙肝表面抗原（HBsAg）的阳性活体供体向HBsAg阴性接受

StephenW

Kidney Transplantation From Hepatitis B Surface Antigen (HBsAg)–Positive Living Donors to HBsAg-Negative Recipients: Clinical Outcomes at a High-Volume Center in China
Xian-ding Wang, Jin-peng Liu, Tu-run Song, Zhong-li Huang, Yu Fan, Yun-ying Shi, Li-yu Chen, Yuan-hang Lv, Zi-lin Xu, Xiao-hong Li ... Show more
Clinical Infectious Diseases, Volume 72, Issue 6, 15 March 2021, Pages 1016–1023, https://doi.org/10.1093/cid/ciaa178
Published:
26 February 2020
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Abstract
Background

Data on kidney transplantation (KTx) from hepatitis B surface antigen (HBsAg)–positive (HBsAg+) donors to HBsAg-negative (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–positive (HBcAb+) living donors to HBcAb-negative (HBcAb−) recipients [D(HBcAb+)/R(HBcAb−)] were used as the control group. The primary endpoint was posttransplant HBsAg status change from negative to postive (-− →+).
Results

Before KTx, 24 donors (28.9%) in the D(HBsAg+)/R(HBsAg−) group were hepatitis B virus (HBV) DNA positive, and 20 recipients were HBsAb−. All 83 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 of 83 (2.41%) D(HBsAg+)/R(HBsAg−) recipients and 1 of 384 (0.26%) D(HBcAb+)/R(HBcAb−) became HBsAg+, accompanied by HBV DNA-positive (P = .083). The 3 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 = .011), while liver and graft function, rejection, infection, and graft loss were not significantly different. In univariate analyses, pretransplant 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.

StephenW

肾脏从乙肝表面抗原（HBsAg）的阳性活体供体向HBsAg阴性接受者的移植：中国高容量中心的临床结果
王先鼎，刘金鹏，宋土润，黄忠立，余帆，史云英，陈立宇，吕元航，徐子林，李晓红...展示更多
临床传染病，第21卷，2021年3月15日，第1016-1023页，https://doi.org/10.1093/cid/ciaa178
发布时间：
2020年2月26日
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抽象的
背景

从乙肝表面抗原（HBsAg）阳性（HBsAg +）供体到HBsAg阴性（HBsAg-）受体[D（HBsAg +）/ R（HBsAg-）]的肾脏移植（KTx）数据有限。我们旨在报告接受或不接受乙型肝炎表面抗体（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。 384例由活的乙型肝炎核心抗体阳性（HBcAb +）供者向HBcAb阴性（HBcAb-）受者[D（HBcAb +）/ R（HBcAb-）]的KTx患者作为对照组。主要终点是移植后HBsAg状态从阴性变为阳性（-→→）。
结果

在进行KTx之前，D（HBsAg +）/ R（HBsAg-）组中的24位捐献者（28.9％）为乙型肝炎病毒（HBV）DNA阳性，而20位接受者为HBsAb-。所有83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83名（2.41％）D（HBsAg +）/ R（HBsAg-）接受者中的2名和384名（0.26％）D（HBcAb +）/ R（HBcAb-）接受者中的1名成为HBsAg +，并伴有HBV DNA阳性（P = .083）。接受HBsAg-→+的3名接受者仅在KTx之前为HBsAb- / HBcAb-。 D（HBsAg +）/ R（HBsAg-）组的接受者死亡更为频繁（6.02％vs 1.04％，P = .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-→+和死亡的风险明显更高。
结论

HBsAb +接受者的活D（HBsAg +）/ R（HBsAg−）KTx可提供出色的移植物和患者存活率，而无需HBV传播。相对于HBsAb- / HBcAb-候选物中D（HBsAg +）/ R（HBsAg-）KTx的益处，HBV传播风险应更加平衡。