从患有B型肝炎的捐赠者到没有B型肝炎的接受者,故意移植的传播风险:系统性审查和元分析
Karen M J Waller1,2, Nicole De La Mata1, James A Hedley1
1Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
Transplantation
|December 22, 2025
概括
从乙型肝炎病毒 (HBV) 阳性捐赠者到阴性接受者进行移植是可行的. 通过预防,传播风险很低 (4.0%),但仔细选择和监测捐赠者/接受者至关重要.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 肝病学 肝病学是一种肝病学.
- 移植免疫学 移植免疫学
背景情况:
- 具有活性乙型肝炎病毒 (HBV) 的捐赠者通常被排除在乙型肝炎表面抗原 (HBsAg) 阴性接受者之外.
- 接种者疫苗接种和抗病毒预防等策略可以提高安全性,增加移植机会.
- 量化HBV传播风险对于明智作出捐赠决定至关重要.
研究的目的:
- 系统地审查和元分析HBV从活跃的HBV感染捐赠者传播到HBsAg阴性接受者的HBV传播风险.
- 关于使用活跃HBV感染的捐献者器官的临床决策的信息.
主要方法:
- 系统审查和对队列的元分析,使用数据到2024年11月.
- 包括的研究涉及脏捐赠者,活跃的HBV被故意移植到HBsAg阴性接受者身上.
- 传染被定义为移植后的新HBsAg或HBV核酸测试 (NAT) 阳性;使用通用线性混合模型计算了聚合传染率.
主要成果:
- 分析了600名接受者的20个队列;发生了29次传播 (4.0%的聚合率),大多是短暂的.
- 传播率有所不同:较高的阳性供体NAT (16.0%),较低的接收者疫苗接种 (0.8%) 或阳性表面抗体 (1.4%).
- 在没有接受移植后抗病毒预防的接受者中发生了三起死亡.
结论:
- 可以考虑从活跃HBV的捐赠者获得移植.
- 建议进行捐赠者/接受者风险分层,知情同意和预防的警监测.
- 缓解策略可以显著降低传播风险,扩大捐赠者池.
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