Use of anti-HBc positive allografts in adult liver transplantation: toward a safer way to expand the donor pool.

TitleUse of anti-HBc positive allografts in adult liver transplantation: toward a safer way to expand the donor pool.
Publication TypeJournal Article
Year of Publication2006
AuthorsDonataccio D, Roggen F, De Reyck C, Verbaandert C, Bodeus M, Lerut J
Journal//Transpl Int
Volume19
Issue1
Pagination38 - 43
Date Published2006
ISBN Number0934-0874
Other Numbersady, 8908516
Keywordsanti-hepatitis B core donor, Hepatitis B, immunoprophylaxis, Liver Transplantation, marginal donor
Abstract

Summary: The use of livers from anti-hepatitis B core (HBc) positive donors can alleviate donor shortage. Nineteen of 367 (6%) adults receiving anti-HBc positive allografts [three were hepatitis B antigen (HBsAg) negative, hepatitis B antibody (HBsAb) positive; four were HBsAg positive and 12 were not exposed to hepatitis B viral (HBV) infection] were retrospectively reviewed. In HBsAg negative recipients, immunoprophylaxis (IP) was guided by viral serology and immunohistochemistry (IH) of day 0 and day 7 liver biopsies. If IH was negative, IP was stopped. None of three HBsAg negative, HBsAb positive recipients infected; one (replicating) of four HBsAg positive recipients reinfected and seven of eight (87.5%) HBsAg, HBsAb negative recipients, who did not receive long-term IP, infected after a median time of 2 years (range 1-5); one patient died of liver failure. Four HBsAg, HBsAb negative recipients, receiving life-long IP, remained infection free. Anti-HBc positive donor livers must be directed selectively first to HBsAg positive recipients, next to recipients having HBV antibodies and finally to HBV-naive recipients. Identification of both donor and recipient risk factors for HBV infection before transplantation allows indiscriminate use of antiviral prophylaxis. The necessity for IP therapy should be guided by HBV-DNA testing of donor liver tissue and serum. IH of early liver biopsies is an unreliable marker for predicting antiviral treatment requirements., Copyright (C) 2006 Blackwell Publishing Ltd.

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