De novo hepatitis B surface antigen (HBsAg)-positive, core antibody (anti-HBc)-negative, hepatitis B virus infection post-liver transplant from an anti-HBc, HBsAg-negative donor

Abstract

Liver transplant donors and recipients are routinely screened for Hepatitis B virus (HBV) infection with Hepatitis B surface antigen (HBsAg) and Hepatitis B core antibody (anti-HBc).Organs are accepted from donors who are HBV negative, with the caveat of increased monitoring when accepting organs from 'increased risk donors'. Transplant recipients are vaccinated if there is no sign of previous infection or immunity and monitored for reactivation in case of previous HBV infection. In cases where both the donor and recipient are HBV negative, no antiviral prophylaxis is used post-transplant. We present a case of a HBV immunized, anti-HBc negative patient who underwent orthotopic liver transplant from an anti-HBc negative donor. The patient did not receive post-transplant antiviral prophylaxis because of mutual anti-HBc-seronegative status. However, she developed HBV infection with isolated HBsAg, and persistently negative anti-HBc. Mutations in the core/pre-core regions of HBV gene were not implicated for the unique serology in this case. Immunosuppression post-liver transplant is the likely etiology for isolated HBsAg seroconversion despite significantly elevated HBV DNA. Our experience suggests that HBV DNA screening of liver transplant donors and recipients, in addition to HBV DNA monitoring in recipients, may reduce transplant-associated HBV risk.