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

Manzarbeitia, Cosme; Reich, David J.; Ortíz, Jorge; Rothstein, Kenneth D.; Araya, Víctor; Muñoz, Santiago J.

doi:10.1053/jlts.2002.33451

Cited by 84 publications

(144 citation statements)

References 29 publications

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“…[1][2][3][4][5][6][7][8][9][10][11][12] De novo HBV disease can follow an aggressive course, 12,20,21 but it is often mild. 4,5,9 HBV replication is significantly increased with immunosuppression, 22 particularly with corticosteroid use, 23,24 because of the steroid-sensitive transcriptional enhancer element within the HBV genome.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

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...

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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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“…54 In another study, the 1-year actuarial survival rate in 35 liver transplant recipients who received anti-HBcϩ grafts was 88.6% with HBIG and lamivudine prophylaxis. 55 More recently, Joya-Vazquez et al showed that the use of anti-HBc liver grafts does not affect patient or graft survival. 56 With prophylaxis, patient survival was similar at 12 months (85% both groups) and at 60 months (68% anti-HBcϩ; 67% anti-HBcϪ; P ϭ NS).…”

Section: Donors With Viral Hepatitismentioning

confidence: 99%

The utility of marginal donors in liver transplantation

Busuttil¹

2003

Liver Transplantation

629

508

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The shortage of organs has led centers to expand their criteria for the acceptance of marginal donors. The combination of multiple marginal factors seems to be additive on graft injury. In this review, the utility of various marginal donors in patients requiring liver transplantation will be described, including older donors, steatotic livers, non-heart-beating donors, donors with viral hepatitis, and donors with malignancies. The pathophysiology of the marginal donor will be discussed, along with strategies for minimizing the ischemia reperfusion injury experienced by these organs. Finally, new strategies for improving the function of the marginal/expanded donor liver will be reviewed. (Liver Transpl 2003;9:651-663.)

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“…However, the cost of Table 1 Summary of studies for prevention of HBV recurrence after liver transplantation using either HBIg or nucleos(t)ide analogues alone or in combination regimen. Manzarbeitia/2002 [133] Marzano/2005 [62] Marzano/2001 [36] Nery/2003 [14] Table 1 Summary of studies for prevention of HBV recurrence after liver transplantation using either HBIg or nucleos(t)ide analogues alone or in combination regimen.…”

Section: Duration Of Therapymentioning

confidence: 99%