De novo hepatitis B after liver transplantation from hepatitis B core antibody—Positive donors in an area with high prevalence of anti-HBc positivity in the donor population

Abstract

Transmission of hepatitis B virus (HBV) infection from T he acquisition of hepatitis B virus (HBV) infectionafter liver transplantation remains a significant problem in the liver transplant setting. Although de novo HBV infection may occur as a result of the reactivation of occult HBV infection in the recipient, 1,2 recent reports suggest that the vast majority of acquired HBV infections after liver transplantation are related to the donor liver. Liver grafts from donors who are hepatitis B surface antigen negative (HBsAg-) but positive for antibody to hepatitis B core antigen (anti-HBcϩ) have been shown to transmit HBV infection to HBsAg-liver transplant recipients at a rate that ranged from 33% to 78%. [3][4][5][6] However, these results were mostly derived from studies performed in geographic regions with a low prevalence (3% to 4%) of anti-HBc positivity in the liver donor population.The prevalence of HBsAg in the adult Spanish population ranges from 1.2% to 1.7%. 7,8 Accordingly, the prevalence of anti-HBc positivity in the general population is greater than that reported in areas of low prevalence of HBV infection. In a recent study, anti-HBc positivity was found in 10% of the Spanish adults aged 26 to 65 years. 7 In Spain, the current policy of the Organización Nacional de Trasplantes (ONT), the Spanish Organ Procurement Organization, is to test organ donors only for HBsAg. To a certain extent, the liver donor population is a reflection of the general population; therefore, it is reasonable to anticipate that 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 addition, inFrom the *HepatoGastroenterology, †Microbiology, and ‡Pathology Services, and the §Liver Transplantation and

Persistence of isolated antibodies to woodchuck hepatitis virus core antigen is indicative of occult infection

“…32,39,40 These findings are consistent with our earlier reports of SOI continuing for life after termination of acute WHV hepatitis, 30,32,37 along with documented infectivity and liver pathogenic competence of the silently carried virus. 30,32 The current results also agree with the data from the limited studies of apparently healthy individuals reactive for anti-HBc alone or anti-HBc and anti-HBs, which showed presence of HBV cccDNA and HBV RNA in their liver 8,41 and transmission of HBV by liver grafts [15][16][17][18][19][20][21] or blood [42][43][44] to virusnaïve recipients.…”

“…This outcome was consistent with the earlier findings of anti-HBc along with HBV DNA in serum and peripheral blood mononuclear cells (PBMC) 12 and a vigorous cytotoxic T-lymphocyte response to HBV antigens in apparently completely healthy individuals years after recovery from acute hepatitis B. 13,14 Moreover, transmission of HBV from blood and organ donors with isolated anti-HBc to virus-naïve individuals 5,[15][16][17][18][19][20][21] and reactivation of the infection in anti-HBc-positive persons 22,23 have been reported. Also, it is perceived that occult HBV infection with or without anti-HBc is associated with an increased risk of developing hepatocellular carcinoma.…”

Liver transplantation with allografts from hepatitis B core antibody-positive donors: A new approach

“…Several studies have reported a 16.6% to 95% increased incidence for HBV infection in these patients. [1][2][3][4][5][6][7][8][9][10][11][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.…”

Safe use of livers from donors with positive hepatitis B core antibody

“…4,5 There have been documented instances of de novo occurrence of hepatitis B (HBV) infection in recipients of these organs. 3,5,[6][7][8][9][10][11] The reported rates of de novo HBV in HBcAb-negative recipients receiving an HBcAb-positive donor liver vary from 30% [6][7][8] to up to 80% 3,9,20 when no antiviral prophylaxis is used after surgery.…”