PREVENTION OF DE NOVO HEPATITIS B INFECTION IN RECIPIENTS OF HEPATIC ALLOGRAFTS FROM ANTI-HBc POSITIVE DONORS

Dodson, S. Forrest; Bonham, Clark A.; Geller, David A.; Cacciarelli, Thomas V.; Rakela, Jorge; Fung, John J.

doi:10.1097/00007890-199910150-00028

Cited by 142 publications

(164 citation statements)

References 12 publications

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“…[31][32][33] Previous studies have recommended that the patients who receive anti-HBc-positive organs should undergo a minimum of one year of lamivudine or HBIg prophylaxis, regardless of their own HBV status, because their grafts harbor HBV and can cause disease in the transplant recipient. 10,[13][14][15] The disadvantages of HBIg in combination with lamivudine are exceedingly high cost, inconvenient usage, possible mercury intoxication in some preparations, and the emergence of a resistant mutant virus. 16,17,34,35 However, there are uncertain conclusions regarding the prophylactic management after transplantation in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…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, this prophylactic treatment is very expensive and has been associated with the emergence of a resistant HBV strain, because of a specific mutation in the HBV-RNA-dependent DNA polymerase at the tyrosine-methionine-aspartate-aspartate locus. 16,17 The more precise definition of HBV infection is the identification of HBV-DNA in the serum or tissue of the suspected viral host.…”

Section: E Novo Hepatitis B Virus (Hbv) After Orthotopicmentioning

confidence: 99%

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

Fábrega

García-Suárez

Guerra

et al. 2003

Liver Transplantation

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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...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: E Novo Hepatitis B Virus (Hbv) After Orthotopicmentioning

confidence: 99%

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

Fábrega

García-Suárez

Guerra

et al. 2003

Liver Transplantation

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show abstract

“…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.…”

mentioning

confidence: 99%

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

Manzarbeitia

Reich

Ortíz

et al. 2002

Liver Transplantation

138

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“…[1][2][3][4][5][6][7][8][9][10][11] Progressive liver disease can develop in these patients. 2,5,9 Antibody to HBsAg (antiHBs) ϩ transplant recipients have the lowest risk for developing de novo HBV infection from an anti-HBc ϩ liver allograft.…”

mentioning

confidence: 99%

“…Recipients positive only for anti-HBc have an intermediate risk (13%), and those negative for both anti-HBc and anti-HBs have the greatest risk (72%) for de novo infection. 3,4 Hepatitis B immunoglobulin (HBIG) is routinely administered to prevent the recurrence of HBV infection in HBV-infected liver transplant recipients. Two studies using an HBIG-based regimen successfully prevented de novo HBV infection in recipients of antiHBc ϩ allografts.…”

mentioning

confidence: 99%

Transmission of hepatitis B infection from hepatitis B core antibody–positive liver allografts is prevented by lamivudine therapy

Yu¹

2001

Liver Transplantation

100

110

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PREVENTION OF DE NOVO HEPATITIS B INFECTION IN RECIPIENTS OF HEPATIC ALLOGRAFTS FROM ANTI-HBc POSITIVE DONORS

Abstract: Combination therapy with HBIG and lamivudine may prevent de novo HBV infection in anti-HBs-, HbsAg- recipients of hepatic allografts from anti-HBc+ donors.

Cited by 142 publications

References 12 publications

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

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

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

Transmission of hepatitis B infection from hepatitis B core antibody–positive liver allografts is prevented by lamivudine therapy

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