Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology · 2010
Successful outcome of kidney transplantation from a HBV-DNA positive donor into recipients with cleared HBV-infection using a pre-emptive therapy approach.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Mohrbach Janine, Janssen Martin W W, Heine Gunnar H, Gärtner Barbara C, Fliser Danilo, Sester Martina, Sester Urban
Аннотация
BACKGROUND: Donor-derived transmission of hepatitis B virus (HBV) may cause serious complications after transplantation. To date, transplantation from HBV-infected donors to HBV-infected recipients seems feasible, although this is recommended with prophylaxis with specific drugs and antibodies only, whereas pre-emptive strategies are rarely used.
OBJECTIVES: Here, we assessed the success of transplantation of kidneys from a chronically HBV-infected deceased donor (HBs-antigen positive, anti-HBc positive, HBV-DNA positive) to two recipients with cleared HBV-infection (HBs-antigen negative, anti-HBc positive, anti-HBs >100 IU/l) where risk-assessment was performed using a pre-emptive approach in the absence of prophylaxis.
STUDY DESIGN: Pre-emptive monitoring included assessment for evidence of infection by analysis of liver enzymes, viral load, and humoral and cellular immunity against HBV and CMV.
RESULTS: In line with undetectable HBV-load, HBc-specific T-cell frequencies remained stable (mean 0.46+/-0.10% and 0.06+/-0.03%), whereas CMV-specific T-cell frequencies in one patient showed dynamic changes that coincided with CMV-viremia. Likewise, HBV-specific antibody titres were stable. Liver enzymes demonstrated absence of liver-cell injury and renal function was good (creatinine 1.8 and 0.8 mg/dl at last follow-up after 39 and 38 months, respectively).
CONCLUSIONS: When combined with careful HBV-monitoring, kidneys from HBV-infected donors may be transplanted into HBV-immune recipients without the need for specific prophylaxis.
OBJECTIVES: Here, we assessed the success of transplantation of kidneys from a chronically HBV-infected deceased donor (HBs-antigen positive, anti-HBc positive, HBV-DNA positive) to two recipients with cleared HBV-infection (HBs-antigen negative, anti-HBc positive, anti-HBs >100 IU/l) where risk-assessment was performed using a pre-emptive approach in the absence of prophylaxis.
STUDY DESIGN: Pre-emptive monitoring included assessment for evidence of infection by analysis of liver enzymes, viral load, and humoral and cellular immunity against HBV and CMV.
RESULTS: In line with undetectable HBV-load, HBc-specific T-cell frequencies remained stable (mean 0.46+/-0.10% and 0.06+/-0.03%), whereas CMV-specific T-cell frequencies in one patient showed dynamic changes that coincided with CMV-viremia. Likewise, HBV-specific antibody titres were stable. Liver enzymes demonstrated absence of liver-cell injury and renal function was good (creatinine 1.8 and 0.8 mg/dl at last follow-up after 39 and 38 months, respectively).
CONCLUSIONS: When combined with careful HBV-monitoring, kidneys from HBV-infected donors may be transplanted into HBV-immune recipients without the need for specific prophylaxis.