中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (18): 3367-3370.doi: 10.3969/j.issn.1673-8225.2011.18.034

• 器官移植学术探讨 academic discussion of organ transplantation • 上一篇    下一篇

乙肝核心抗体阳性供肝在肝移植中的应用

陆浩然1，蔡秋成2，吕立志2，陈少华2，江  艺2   

  1. 1安徽医科大学，安徽省合肥市 230032
    2解放军南京军区福州总医院肝胆病中心，福建省福州市  350002
  • 收稿日期:2010-12-08 修回日期:2011-01-11 出版日期:2011-04-30 发布日期:2011-04-30
  • 通讯作者: 江艺，主任医师，博士生导师，解放军南京军区福州总医院肝胆病中心，福建省福州市 350002 aylhr@163.com
  • 作者简介:陆浩然★，男，1986年生，山东泗水县人，汉族，安徽医科大学在读硕士。主要从事肝移植方面的研究。 aylhr@163.com
  • 基金资助:

    南京军区医学科技技术研究“十一五”计划课题(06Z46)：树鼩乙型肝炎肝移植模型的建立及移植后乙型肝炎病毒动力学研究。

Application of liver grafts from anti-hepatitis B core positive donors

Lu Hao-ran1, Cai Qiu-cheng2, Lü Li-zhi2, Chen Shao-hua2, Jiang Yi2   

  1. 1Anhui Medical University, Hefei  230032, Anhui Province, China
    2Center of Liver and Gallbladder Diseases, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA, Fuzhou  350002, Fujian Province, China
  • Received:2010-12-08 Revised:2011-01-11 Online:2011-04-30 Published:2011-04-30
  • Contact: Jiang Yi, Chief physician, Doctoral supervisor, Center of Liver and Gallbladder Diseases, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA, Fuzhou 350002, Fujian Province, China aylhr@163.com
  • About author:Lu Hao-ran★, Studying for master’s degree, Anhui Medical University, Hefei 230032, Anhui Province, China aylhr@163.com
  • Supported by:

    Eleventh-Five-year plan of Science and Technology Plan in Nanjing Military Area Command, No.06Z46*

PDF

508

被引次数

5

摘要：

背景：现已经证实使用anti-HBc(+)供肝会使移植后乙肝复发的风险，但anti-HBc(+)供肝的应用明显缓解了供肝的相对匮乏。
目的：分析应用anti-HBc(+)供肝移植后乙肝复发风险及有效的预防措施。
方法：应用计算机检PubMed数据库中1994-01/2009-12关于anti-HBc(+)供肝文章，在标题和摘要中以“Hepatitis B core antibody; donor；liver transplantation”为检索词进行检索。选择与anti-HBc供肝相关文章。初检得到109篇文献，根据纳入标准选择48篇文章进行综述。
结果与结论：HBsAg(+)患者接受anti-HBc(+)供肝移植术后乙肝复发率为11%，生存率为67%~100%，与HBsAg(+)受者接受anti-HBc(-)供肝相似。HBsAg(-)受者接受anti-HBc(+)供肝总体感染率为19%，其中未感染过乙肝受者移植术后乙肝感染率为48%，感染过乙肝受者后感染率为15%。未感染乙肝与感染过乙肝受者移植后采取有效预防措施后感染率分别为3%，12%。采用HBIG、拉米夫定、联合用药的移植后感染率分别为19%，2.6%，2.8%。提示，采用anti-HBc(+)供肝做为供体是安全的，尤其是用在HBsAg(+)、anti-HBc(+)、anti-HBs(+)受者。而HBsAg(-)受者移植后接受拉米夫定可以有效复发乙肝感染。

关键词: 乙肝核心抗体, 肝移植, 乙肝核心抗体, 乙肝, 供体, 阳性

Abstract:

BACKGROUND: Utilization of anti-HBc positive liver anti-HBc positive graft relieves organ shortage despite it increases risk of hepatitis B virus (HBV) recurrence after liver transplantation.
OBJECTIVE: To evaluate the risk of HBV infection after liver transplantation with anti-HBc positive donors and anti-HBV prophylaxis.
METHODS: The PubMed database was researched using a computer for articles published from January 1994 to December 2009 using the key words of “hepatitis B core antibody; donor; liver transplantation” in English. We performed a literature review over the last 15 years identifying 39 studies including 903 recipients of anti-HBc positive liver grafts.
RESULTS AND CONCLUSION: Recurrent HBV infection developed in 11% of HBsAg-positive liver transplant recipients of anti-HBc positive grafts, while survival was similar (67%–100%) to HBsAg-positive recipients of anti-HBc negative grafts. Neonatal HBV infection developed in 19% of HBsAg-negative recipients being less frequent in anti-HBc/anti-HBs positive than HBV negative cases without prophylaxis (15% vs. 48%). Anti-HBV prophylaxis reduced neonatal infection rates in both anti-HBc/anti-HBs positive (3%) and HBV naive recipients (12%). Neonatal infection rates were 19%, 2.6% and 2.8% in HBsAg-negative recipients under hepatitis B immune-globulin, lamivudine and their combination, respectively. Liver grafts from anti-HBc positive donors can be safely used, preferentially in HBsAg-positive or anti-HBc/anti-HBs positive recipients. HBsAg-negative recipients should receive prophylaxis with lamivudine.

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