Prevention of de novo HBV infection by the presence of anti-HBs in transplanted patients receiving core antibody-positive livers

瞄准：分析在肝的 anti-HBs 的存在是否移植接受者在阻止 HBV 感染是有效的。方法：23 个病人收到 anti-HBc 积极的肝被学习。九个接受者是由于以前的 HBV 感染积极的 anti-HBc。他们，一个人也收到了在肝前移植时期期间疫苗的 HBV。十四个接受者是由于在预先移植经期期间管理的 HBV 疫苗积极的 anti-HBs。肝活体检视在 10/14 anti-HBc negative/anti-HBs 被获得积极接受者并且在 4/9 anti-HBc 积极接受者。结果：在 46 个月的一个吝啬的后续时期以后，有保护的浆液 anti-HBs 层次的 1 个接受者作为有免疫力的逃跑 HBV 异种的后果得了 de novo HBV 感染。在 14 之中种牛痘的 anti-HBc negative/anti-HBs 积极接受者，有可得到的肝活体检视(10%) 的 1/10 病人在 13 瞬间有肝 HBV-DNA 没有浆液的肝以后的移植病毒的标记并且没得 de novo HBV 感染。种牛痘的 anti-HBc 没有 HBV 疫苗的反应的积极接受者是在浆液和肝积极的 HBV-DNA，病毒的 DNA 在下列测试是连续地否定的，自发的 seroconversion 因此被诊断。结论：由于 HBV 疫苗或过去的 HBV 感染的 anti-HBs 的存在似乎在保护从 anti-HBc 收到肝的病人有效积极施主。然而，有免疫力的逃跑 HBV 异种的出现，能躲避 anti-HBs 保护，应该被看作 HBV 感染的风险。

AIM： To analyze whether the presence of anti-HBs in liver transplant recipients is effective in preventing HBV infection. METHODS： Twenty-three patients receiving anti-HBc positive liver were studied. Nine recipients were anti-HBc positive as a result of previous HBV infection. Of them, one also received HBV vaccine during the pre-liver transplantation period. Fourteen recipients were anti-HBs positive due to HBV vaccine administered during the pretransplant period. Liver biopsy was obtained in 10/14 anti-HBc negative/anti-HBs positive recipients and in 4/9 anti-HBc positive recipients. RESULTS： After a mean foUow-up period of 46 months, 1 recipient with protective serum anti-HBs levels developed de novo HBV infection as a consequence of immune escape HBV mutants. Among the 14 vaccinated anti-HBc negative/anti-HBs positive recipients, 1/10 patients with available liver biopsy （10%） had liver HBV-DNA at 13 mo post-liver transplantation without serum viral markers and did not develop de novo HBV infection.The vaccinated anti-HBc positive recipient without HBV vaccine response was HBV-DNA positive in serum and liver, viral DNA was continuously negative in the following tests, so a spontaneous seroconversion was diagnosed. CONCLUSION： The presence of anti-HBs as a result of HBV vaccine or past HBV infection seems to be effective at protecting patients receiving livers from anti-HBc positive donors. However, the emergence of immune escape HBV mutants, which can evade the anti-HBs protection, should be considered as a risk of HBV infection.