Outcomes and risk factors for hepatitis B virus (HBV) reactivation after kidney transplantation in occult HBV carriers
Outcomes and risk factors for hepatitis B virus (HBV) reactivation after kidney transplantation in occult HBV carriers
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DOI：
10.1111/tid.12065
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发表时间：
2013-06-01
影响因子：
2.6
通讯作者：
Chen, L. -Z.
中科院分区：
文献类型：
--
作者：
Chen, G. -D.;Gu, J. -L.;Chen, L. -Z.
目的探讨肾移植术前B肝炎表面抗原（HBsAg）阴性、乙型肝炎核心抗体（HBcAb）阳性的隐匿性HBV携带者肾移植术后B肝炎病毒（HBV）再激活的影响因素。方法回顾性分析1998年1月至2008年6月在我院接受肾移植的322例隐匿性乙型肝炎病毒携带者。常规检查HBsAg和HBV DNA以诊断HBV再激活。结果15例隐匿性HBV携带者在肾移植术后发生HBV再激活，发生率为4.7%。Kaplan-Meier分析显示，HBV再激活组1、3、5和10年患者生存率分别为86.7%、79.4%、72.2%和65.0%，非HBV再激活组分别为96.1%、93.8%、91.5%和84.5%（对数秩4.12，P=0.042）。移植物存活率在这两组之间没有差异（0.05）。HBV再激活组肝功能损害、肝功能衰竭、肝细胞癌和急性排斥反应的发生率明显高于非HBV再激活组（P60）和使用抗T细胞抗体是肾移植术后HBV再激活的独立危险因素，而B型肝炎表面抗体（HBVAb）阳性的患者在肾移植术后应用拉米夫定预防治疗可保护隐匿性HBV携带者免于HBV再激活（P
Purpose The purpose of this study was to explore the outcomes and risk factors for hepatitis B virus (HBV) reactivation after kidney transplantation in occult HBV carriers, who are hepatitis B surface antigen (HBsAg) seronegative and hepatitis B core antibody (HBcAb) seropositive before kidney transplantation. Methods We retrospectively analyzed 322 occult HBV carriers who received kidney transplantation in our hospital from January 1998 to June 2008. HBsAg and HBV DNA were routinely checked for diagnosis of HBV reactivation. Results Our results showed that 15 cases (4.7%) of occult HBV carriers had HBV reactivation after kidney transplantation. Kaplan-Meier analysis showed that 1-, 3-, 5-, and 10-year patient survival was 86.7%, 79.4%, 72.2%, and 65.0%, respectively, in the HBV reactivation group, and was 96.1%, 93.8%, 91.5%, and 84.5%, respectively, in the non-HBV reactivation group (log-rank 4.12, P=0.042). Graft survival showed no difference between these 2 groups (0.05). The incidences of impairment of liver function, liver function failure, hepatocellular carcinoma, and acute rejection were significantly higher in the HBV reactivation group compared with the non-HBV reactivation group (P60years) and using anti-T-cell antibodies were independent risk factors for HBV reactivation after kidney transplantation, while being hepatitis B surface antibody (HBsAb) seropositive and using lamivudine prophylaxis could protect occult HBV carriers from HBV reactivation after kidney transplantation (P