Abstract：Objective To study the selective use of donor livers after cardiac death (DCD) with hepatitis B surface antigen (HBsAg) positive and its effect on the prognosis of liver transplantation.Methods With informed consent, liver transplantation recipients of HBsAg positive cardiac dead organs donated by our hospital were studied, where bidirectional cohort study was used. Intraoperative zero hepatic biopsy specimens were obtained from each of these cases, and the secondary hepatic biopsy was performed on patients with a lifespan of more than 1 year. The status of hepatitis B virus, liver function biochemical index, coagulation function and patient survival after liver transplantation were analyzed. Liver fibrosis and inflammation changes before and after surgery were compared.Results The 1-year, 3-year and 5-year survival rates of liver transplant recipients were 86.8%, 75.5% and 62.3% respectively. Serum HBsAg of each patient was positive during the follow-up, but HBV-DNA was well controlled. the liver function of the survivors was good at 1 year after operation. The degree of inflammation of the liver perforating tissue was significantly reduced during postoperative follow-up (1.98±0.67 vs 1.65±0.79, P=0.02), while the degree of fibrosis was not significantly changed (0.83±0.58 vs 0.68±0.61, P=0.31). The degree of zero-point liver tissue inflammation was not related to the liver function at 1 year after surgery, while the degree of liver tissue fibrosis was positively correlated with total bilirubin (TBIL), International Normalized Ratio (INR) and Model for End-Stage Liver Disease (MELD score) at 1 year after surgery. The correlation coefficients were 0.56 (P=0.04), 0.59 (P=0.02) and 0.68 (P=0.01), respectively. In this study, 20 patients died during the follow-up, including 3 patients with primary hepatic reactive power, 2 patients with F2 stage (2/12), 1 patient with F3 stage (1/3), 11 patients with tumor recurrence, 5 patients with infection and 1 patient with gastrointestinal hemorrhage.Conclusions For HBsAg positive DCD donor livers, zero hepatic histopathological examination is of great significance in guiding the rational use of donor livers, F0 stage and F1 stage can be used normally, F2 stage is suitable for patients with mild disease, and F3 stage should not be used. With careful selection of donor receptors and proper anti-hepatitis measures, donor livers can be fully utilized and good prognosis can be obtained.
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2019, Vol. 30 
