The Risk Of Transmission Of Hepatitis B From Hbsag(-), Hbcab(+), Hbigm(-) Organ Donors
The Risk Of Transmission Of Hepatitis B From Hbsag(-), Hbcab(+), Hbigm(-) Organ Donors
复制标题
Hbsag(-)、Hbcab( )、Hbigm(-) 器官捐献者传播乙型肝炎的风险
作者：
M. Wachs;W. Amend;N. Ascher;P. Bretan;J. Emond;J. Lake;J. Melzer;J. Roberts;S. Tomlanovich;F. Vincenti;P. Stock
来自HBcAb（+）、IgM（-）、HBsAg（-）供者的肝移植可将HBV传播给未感染的受者。我们目前不再接受这些肝脏移植，而继续接受肾脏。本研究的目的是确定来自HBcAb（+）、HBIgM（-）、HBsAg（-）器官供体的供体传播HBV感染的风险，并确定供体传播HBV感染的风险及其严重程度是否取决于移植的器官。本研究包括对UCSF从6/85到12/93接受的HBcAb（+）、HBIgM（-）、HBsAg（-）供者的移植后病程的回顾性分析。传播性HBV感染定义为受者从移植前HBsAg（-）变为移植后HBsAg（+），无其他来源。1190例供者中有25例为HBcAb（+）、HBIgM（-）、HBsAg（-）; 1/42例肾、3/6例肝和0/7例心脏HBsAg（-）供者器官移植后HBsAg（+）。这种感染率的差异（肝脏与肾脏和心脏）具有统计学意义。肝脏受体的临床过程也更严重。所有感染的患者在移植前均为HBcAb（-）和HBcAb（-）。我们的结论是：（1）HBV可以从HBcAb（+），HBIgM（-），HBsAg（-）器官供体传播，（2）在肝脏受体中传播率最高，感染的严重程度最严重;（3）我们将继续从这些供体移植肾脏，最好是免疫受体。
Liver allografts from HBcAb(+), IgM(-), HBsAg(-) donors can transmit HBV to uninfected recipients. We currently no longer accept these livers for transplantation while continuing to accept the kidneys. The purpose of this study is to determine the risk of donor-transmitted HBV infections from HBcAb(+), HBIgM(-), HBsAg(-) organ donors and determine if the risk of donor-transmitted HBV infections and their severity is dependent on the organ being transplanted. This study consists of a retrospective review of the posttransplant course of recipients of HBcAb(+), HBIgM(-), HBsAg(-) donors accepted at UCSF from 6/85 to 12/93. Transmitted HBV infection was defined as one in which the recipient changed from HBsAg(-) prior to transplantation to HBsAg(+) posttransplant, with no other source. There were 25 of 1190 donors who were HBcAb(+), HBIgM(-), HBsAg(-); 1/42 kidney, 3/6 liver, and 0/7 heart HBsAg(-) transplant recipients of organs from these donors became HBsAg(+) after transplantation. This difference in infection rate (liver vs. kidney and heart) is statistically significant. The clinical course of the liver recipients was also more severe. All of the patients who became infected were HBsAb(-) and HBcAb(-) prior to transplant. We conclude that (1) HBV can be transmitted from HBcAb(+), HBIgM(-), HBsAg(-) organ donors, (2) the rate of transmission is highest and severity of infection is worst in the liver recipients; and (3) we will continue to transplant kidneys from these donors, preferably into immunized recipients.