不知道我的想法能否成立

爱唱歌的猪

回复 StephenW 的帖子

根据肝移植版块的“爽风”老先生的帖子（大家可以去完整阅读）提供的信息：

基本思路为：1：肝移植前期先使用拉米将表面抗原降低到非常滴的滴度。
                  2：肝移植完成后，注射高剂量的乙肝免疫球蛋白中和血液中残存的抗原，以免再度感染新的肝脏。我记得爽老的帖子里说的是要保证这个抗体的滴度非常高（数千）。
                  3：在恰当的时候注射乙肝疫苗，以刺激产生自身抗体。

爽老先生根据他肝移植的众多病友提供的信息是，这种方法可以保证绝大部分的病友避免二度感染乙肝病毒。


对于病毒免疫学，我是个外行，所以我尽可能不提供个人意见，而使用前辈的意见。

我知道 StephenW 是本论坛的功勋人物， 讨论之余特表达我个人内心里对StephenW对论坛所做的大量工作的感谢。


非常感谢。

StephenW

回复 爱唱歌的猪 的帖子

看看这个, 以前感染的肝(HBcAb+)也可以用于肝脏移植手术.结果是相同使用未受感染的肝.
"All patients received immunoglobulin and longterm antiviral therapy as prophylaxis against graft hepatitis B resurgence. " 所有患者都接受免疫球蛋白和长期抗病毒治疗预防对移植肝
的B型肝炎的复苏。


HPB (Oxford). 2012 Jan;14(1):42-8. doi: 10.1111/j.1477-2574.2011.00399.x.
Epub 2011 Nov 2. Utilization of hepatitis B core antibody-positive donor
liver grafts. Source: http://www.ncbi.nlm.nih.gov/pubmed/22151450
Macconmara MP, Vachharajani N, Wellen JR, Anderson CD, Lowell JA, Shenoy S,
Chapman WC, Doyle MB. SourceSection of Transplant Surgery, Department of
Surgery, Washington University in St Louis, St Louis, MO, USA.

Abstract
Background:  The inclusion of hepatitis B core antibody-positive (HBcAb+)
liver donors is a strategy utilized to increase organ availability. This
study examined HBcAb+ transplantation practices to identify specific
factors influencing outcomes. Methods:  Twenty-five HBcAb+ liver
transplants were identified retrospectively among 868 adult transplants
performed between 1 January 1997 and 31 December 2009. Twelve (48%)
recipients had hepatitis C and five (20%) had hepatitis B. Patient and
donor demographics, preoperative morbidity, transplant data and outcomes
were examined. Statistical analysis was completed using Student's t-test or
the Kaplan-Meier method. A P-value of <0.05 was considered significant.
Results:  There was no difference in age, body mass index or comorbidities
between HBcAb+ liver recipients and control subjects. Model for End-stage
Liver Disease (MELD) scores of >30 were significantly more frequent in
HBcAb+ liver recipients (32% vs. 15%; P= 0.04). All patients received
immunoglobulin and longterm antiviral therapy as prophylaxis against graft
hepatitis B resurgence. No patients who received HBcAb+ livers developed
hepatitis B infection on follow-up. Overall survival at 30 days, 1 year and
5 years in HBcAb+ liver recipients was 92%, 74% and 74%, respectively,
compared with 96%, 89% and 76%, respectively, in the control group (P= not
significant, log-rank test). All except one of the deaths in the HBcAb+
liver recipient group occurred within 90 days postoperatively and in
patients with MELD scores >30. Conclusions:  The practice of transplanting
HBcAb+ grafts incurs low risk for infection using current methods of
prophylaxis. The highest mortality risk was in the early postoperative
period, specifically in patients with very high MELD scores. This probably
reflects the practice of using positive serology grafts in emergent
situations.

lanwj

肝移植后又复发，应该不仅仅是血液中还有残留的病毒，我好像在论坛哪里看到病毒还可以侵入除了肝脏以外的其它细胞，还有其它藏身地点。
肝脏是病毒的主要宿主细胞，但病毒可能还有除肝脏以外的宿主细胞。

爱唱歌的猪

回复 lanwj 的帖子




记忆中好像是肾脏，抗原可以引起少部分携带者的肾炎。