The enduring shortfall of organ donors has inspired the widespread utilization of hepatic allografts from donors with hepatitis B core antibodies in spite of the potential risk of transmitting hepatitis B virus (HBV) infection to the recipient. Here we report a protocol of naive recipients receiving livers from hepatitis B core antibody-positive donors. From November, 1999 to March, 2002, 77 liver transplantations were performed in 73 patients at our institution, 7 of whom received livers from hepatitis B core antibody-positive donors. All recipients received 10,000 U/d of intravenous HBIg for 7 days and 100 mg /d of lamivudine until we could obtain the HBV-DNA from the donor samples (serum and liver tissue). If the results of the HBV-DNA from the donor samples were positive, the patient would continue with prophylaxis and if they were negative we would finish the combined prophylaxis. After transplantation, HBV serologic markers and HBV-DNA by polymerase chain reaction (PCR) in serum and lymphocytes were tested in the recipients on the seventh, fifteenth, thirtieth, and ninetieth days as well as every 3 months after transplantation. All seven donor organs were negative for HBV-DNA in serum and liver tissue. Thus, we stopped the combined prophylaxis in all recipients (range, 7 to 10 days). None of the 7 patients developed de novo HBV infection over the 3-year study period (range, 9 to 36 months). Our approach is reasonably safe, and it appears to be very effective in the prevention of de novo HBV infection after liver transplantation. (Liver Transpl 2003;9:916-920.) D e novo hepatitis B virus (HBV) after orthotopic liver transplantation (OLT) has been reported in recipients negative for hepatitis B surface antigen (HBsAg) from hepatitis B core antibody (anti-HBc)-positive donors. Several studies have reported a 16.6% to 95% increased incidence for HBV infection in these patients. 1-12 As a result, many centers do not use antiHBc-positive donors for recipients without previous HBV infection. 11 These results were derived mostly from studies performed in geographic regions with a low prevalence (3% to 5%) of anti-HBc-positive liver donors. However, in a recent study, anti-HBc positivity was found in 10% of the Spanish adults in the 26 to 65 age range and in 27% of donors older than 60. 2 For this reason, the prevalence of anti-HBc positivity in Spanish liver donors and, thus, the incidence of de novo HBV infection after liver transplantation would be greater in our area than in areas of lower prevalence.In an attempt to prevent transmission of HBV infection to recipients from donors positive for anti-HBc, polyclonal hepatitis B immunoglobulin (HBIg) has been administered to the recipients almost universally. Many centers use HBIg either continuously or for an indefinite amount of time, usually 2 or more years after OLT. 10 Recent studies have suggested that lamivudine, a nucleoside analog that inhibits HBV replication, can be used in addition to or as an alternative to HBIg in such cases. [13][14][15] However, thi...

Non-alcoholic fatty liver disease (NAFLD) is characterized by an excessive accumulation of fatty acids and triglycerides within the cytoplasm of the hepatocytes of non-alcohol users. The natural history varies according to the initial histological diagnosis. A current consideration is that cryptogenic cirrhosis may be representative of a late stage of non-alcoholic steatohepatitis (NASH), which has lost its features of necroinflammatory activity and steatosis in up to 80% of patients. Since NASH is able to progress to cirrhosis, hepatocellular carcinoma (HCC) development may be an end-stage of this disease. We report below two clinical cases of patients diagnosed with NASH who developed HCC. The relationship between NAFLD and HCC is reviewed.

OPG might partly represent a compensating mechanism to the negative balance of bone remodelling in patients with alcoholic cirrhosis.

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