Adult Living Donor Liver Transplantation Using Hepatitis B Core Antibody-Positive Grafts in Korea, a Hepatitis B-endemic Region
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background/Aims: The exclusion of hepatitis B core antibody (HBcAb)-positive donors from liver transplants (LTs) due to the risk of transmitting hepatitis B virus (HBV) does not appear to be practical in Korea, where hepatitis B is endemic. This study assessed the risk of de novo HBV infection in hepatitis B surface antigen (HBsAg)-negative LT recipients receiving a liver from HBcAb-positive donors. Methods: Of 341 adult living donor LTs conducted at our institution between March 2001 and September 2008, 176 donors (51.6%) were HBcAb-positive, and 26 HBcAb-positive grafts were transplanted to HBsAg-negative recipients. The median follow-up time after LT was 41.9 months. Results: Without anti-HBV prophylaxis, 2 out of 26 (7.7%) HBsAg-negative recipients who received grafts from HBcAb-positive donors developed de novo HBV infection 20 and 85 months after LT. These patients had been negative for all HBV serologic markers before transplantation. In both cases, there were no abnormalities in liver function tests upon diagnosis of de novo HBV infection. Conclusions: De novo HBV infection from HBcAb-positive donors after LT does not appear to be of great concern in terms of the number of cases in Korea because high risk patients who are HBV-negative comprise only a small proportion of the recipients. However, HBV-naïve LT recipients still carry the risk of developing de novo HBV infection as in non-HBV endemic areas.
Abstract
Background/Aims: The exclusion of hepatitis B core antibody (HBcAb)-positive donors from liver transplants (LTs) due to the risk of transmitting hepatitis B virus (HBV) does not appear to be practical in Korea, where hepatitis B is endemic. This study assessed the risk of de novo HBV infection in hepatitis B surface antigen (HBsAg)-negative LT recipients receiving a liver from HBcAb-positive donors. Methods: Of 341 adult living donor LTs conducted at our institution between March 2001 and September 2008, 176 donors (51.6%) were HBcAb-positive, and 26 HBcAb-positive grafts were transplanted to HBsAg-negative recipients. The median follow-up time after LT was 41.9 months. Results: Without anti-HBV prophylaxis, 2 out of 26 (7.7%) HBsAg-negative recipients who received grafts from HBcAb-positive donors developed de novo HBV infection 20 and 85 months after LT. These patients had been negative for all HBV serologic markers before transplantation. In both cases, there were no abnormalities in liver function tests upon diagnosis of de novo HBV infection. Conclusions: De novo HBV infection from HBcAb-positive donors after LT does not appear to be of great concern in terms of the number of cases in Korea because high risk patients who are HBV-negative comprise only a small proportion of the recipients. However, HBV-naïve LT recipients still carry the risk of developing de novo HBV infection as in non-HBV endemic areas.
참고문헌 (16)
- Wachs ME, "The risk of transmission of hepatitis B from HBsAg(-), HBcAb(+), HBIgM(-) organ donors", Transplantation, 59, pp.230~234 (1995)
- Donataccio D, "Bodeus M, Lerut J. Use of anti-HBc positive allografts in adult liver transplantation: toward a safer way to expand the donor pool", Transpl Int, 19, pp.38~43 (2006)
- Prieto M, "De novo hepatitis B after liver transplantation from hepatitis B core antibody-positive donors in an area with high prevalence of anti-HBc positivity in the donor population", Liver Transpl, 7, pp.51~58 (2001)
- Rokuhara A, "De novo infection of hepatitis B virus in patients with orthotopic liver transplantation: analysis by determining complete sequence of the genome", J Med Virol, 62, pp.471~478 (2000)
- Roche B, "De novo and apparent de novo hepatitis B virus infection after liver transplantation", J Hepatol, 26, pp.517~526 (1997)
- Dickson RC, "Transmission of hepatitis B by transplantation of livers from donors positive for antibody to hepatitis B core antigen. The National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database", Gastroenterology, 113, pp.1668~1674 (1997)
- Liu CJ, "Epidemiology of HBV infection in Asian blood donors: emphasis on occult HBV infection and the role of NAT", J Clin Virol, 36(Suppl 1), pp.S33~S44 (2006)
- Avelino-Silva VI, "Liver transplant from Anti-HBc-positive, HBsAg-negative donor into HBsAg-negative recipient: is it safe? A systematic review of the literature", Clin Transplant, 24, pp.735~746 (2010)
- Cholongitas E, "Liver grafts from anti-hepatitis B core positive donors: a systematic review", J Hepatol, 52, pp.272~279 (2010)
- Saab S, "Comparison of different immunoprophylaxis regimens after liver transplantation with hepatitis B core antibody-positive donors: a systematic review", Liver Transpl, 16, pp.300~307 (2010)
- Dodson SF, "Prevention of de novo hepatitis B infection in recipients of hepatic allografts from anti-HBc positive donors", Transplantation, 68, pp.1058~1061 (1999)
- Douglas DD, "The clinical course of transplantation-associated de novo hepatitis B infection in the liver transplant recipient", Liver Transpl Surg, 3, pp.105~111 (1997)
- Lee KW, "Prevention of de novo hepatitis B infection from HbcAb-positive donors in living donor liver transplantation", Transplant Proc, 36, pp.2311~2312 (2004)
- 장성환, "Long-term protection against hepatitis B in pediatric liver recipients can be achieved effectively with vaccination after transplantation", PEDIATRIC TRANSPLANTATION, 10, pp.479~486, BLACKWELL PUBLISHING
- Takemura N, "Liver transplantation using hepatitis B core antibody-positive grafts: review and university of Tokyo experience", Dig Dis Sci, 52, pp.2472~2477 (2007)
- Uemoto S, "Transmission of hepatitis B virus from hepatitis B core antibody-positive donors in living related liver transplants", Transplantation, 65, pp.494~499 (1998)