Hepatitis B virus recurrence after living donor liver transplantation of anti-HBc-positive grafts: A 22-year experience at a single center

Abstract

The use of hepatitis B core antibody (anti-HBc)-positive grafts is one strategy for expanding the donor pool for liver transplantation (LT). The aim of this study was to determine the risk factors associated with hepatitis B virus (HBV) recurrence after living donor LT (LDLT) of anti-HBc-positive grafts. From January 1996 to December 2018, a total of 609 LDLT procedures were performed at our center. A retrospective review was performed for 31 patients (23 males and 8 females; median age = 47 years) who underwent LDLT for HBVunrelated liver disease from anti-HBc-positive donors. The factors associated with HBV recurrence were evaluated and compared between the HBV recurrence and non-recurrence groups. The median follow-up period after LT was 135 months (range, 6-273 months). Four of 31 patients (12.9%) developed post-LT HBV recurrence. All four cases were HBV-naïve patients (anti-HBc-negative and Hepatitis B surface antibody-negative). The median interval between LDLT and HBV recurrence was 42 months (range, 20-51). The overall actuarial rates of HBV recurrence at 1, 3, 5, 10, and 20 years were 0%, 7.2%, 15.7%, 15.7%, and 15.7%, respectively. Although there were no significant differences between the HBV recurrence and non-recurrence groups, HBV recurrence tended to occur in HBV-naïve recipients (P = 0.093). HBV-naïve status may contribute to HBV recurrence after LDLT for HBV-unrelated liver disease from anti-HBc-positive donors. Careful monitoring for serological HBV markers is needed, particularly in this group.

Liver transplantation for young adult patients with post-Kasai portoenterostomy biliary atresia: Analysis of Korean Organ Transplantation Registry database

“…A liver graft recovered from an anti-HBc-positive donor carries a considerable risk of de novo HBV infection because an anti-HBc-positive liver could have occult HBV load in the liver graft [18,19]. Thus, HBV prophylaxis with hepatitis B immunoglobulin or antiviral agent is highly recommended regardless of ant-HBs antibody status [20,21].…”

Evidence‐based clinical practice guidelines for liver cirrhosis 2020

“…To prevent this, the US guidelines recommend prophylactic administration of HBIG for 6-12 months after liver transplantation to recipients of liver transplants from HBc antibodypositive individuals, and Japanese guidelines recommend HBIG administration to reduced HBs antibody titers to 200 IU/L for approximately 1 year after transplantation and to 100 IU/L thereafter. 207,208 CQ6-2. Should we use antiviral therapy before and after liver transplantation for patients with type C cirrhosis?…”

“…Recently, in liver transplantation cases from HBs antigen‐negative or HBc antibody‐positive donors, de novo hepatitis B has been found, and some cases had fulminant hepatitis with poor prognosis. To prevent this, the US guidelines recommend prophylactic administration of HBIG for 6–12 months after liver transplantation to recipients of liver transplants from HBc antibody‐positive individuals, and Japanese guidelines recommend HBIG administration to reduced HBs antibody titers to 200 IU/L for approximately 1 year after transplantation and to 100 IU/L thereafter 207,208 …”

Evidence-based clinical practice guidelines for Liver Cirrhosis 2020

“…Recently, in liver transplantation cases from HBs antigen-negative or HBc antibody-positive donors, de novo hepatitis B has been found, and some cases had fulminant hepatitis with poor prognosis. To prevent this, the US guidelines recommend prophylactic administration of HBIG for 6–12 months after liver transplantation to recipients of liver transplants from HBc antibody-positive individuals, and Japanese guidelines recommend HBIG administration to reduced HBs antibody titers to 200 IU/L for approximately 1 year after transplantation and to 100 IU/L thereafter [ 207 , 208 ].…”