Infectivity of Hepatic Allografts With Antibodies to Hepatitis B Virus

Abstract

Hepatic allografts from donors positive only for anti-HBs do not transmit HBV infection. Hepatic allografts from anti-HBc-positive donors frequently transmit HBV infection to naive recipients regardless of the donor anti-HBs status, and antiviral prophylaxis may be indicated. Anti-HBs-positive recipients appear resistant to HBV infection after orthotopic liver transplantation with an allograft from an anti-HBc-positive donor. Recipients positive only for anti-HBc infrequently develop HBV infection when transplanted with an allograft from an anti-HBc-positive donor; however, HBV prophylaxis may be justified.

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

“…16 About 4% of liver donors are positive for HBcAb. 3 For recip- ients of livers bearing this marker, HBV has been reported to occur anywhere from 30% to 50% 6-8 to up to 78%. 9 This is concerning, because in the absence of therapy, HBV infection can progress to severe allograft dysfunction, graft loss, and even patient death.…”

“…1,2 Because of the severe shortage of organ donors, the transplant community has turned to the use of the so-called extended donors. Among this extended pool are those liver donors with hepatitis B core antibody (HBcAb)-positive serology but negative hepatitis B surface antigen (HBsAg), which can comprise up to 4% of all liver donors 3 ; however, it is unclear whether these organs should be used for transplant. 4,5 There have been documented instances of de novo occurrence of hepatitis B (HBV) infection in recipients of these organs.…”

“…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.…”

Successful pregnancy in a liver transplant recipient treated with lamivudine for de novo hepatitis B in the graft

“…The potential sources of the infection include transfused blood products, occult donor-organ infection and occult pretransplant infection in the recipient. Blood products are occasionally able to transmit HBV despite negative serological testing [14] or past HBV infection [15,161, with an estimated risk for the latter of 33%-78% [17,18,19,201. In the present case two possible sources of HBV infection were identified: sexual transmission from the HBsAg-positive partner or occult transmission from the HBcAb-positive liver donor.…”

A concise update on the status of liver transplantation for hepatitis B virus: The challenges in 2002

“…Several studies have documented a 33% to 78% increased incidence of HBV infection in HBV-naïve recipients of hepatic allografts from donors who were HBsAg negative, but positive for anti-HBc. 64,[76][77][78][79][80][81][82][83][84][85][86][87] Thus, some investigators have suggested that these organs could be safely directed to appropriate recipients, mainly those with anti-HBs and/or anti-HBc at the time of OLT. 64,77,84 The real impact of this recommendation on these transplant recipients has been formally evaluated only recently at the University of Pittsburgh.…”