Liver transplantation in hepatitis B core–negative recipients using livers from hepatitis B core–positive donors: A 13‐year experience

• Published in: Liver transplantation Vol. 19; no. 6; pp. 611 - 618
• Main Authors: Bohorquez, Humberto E., Cohen, Ari J., Girgrah, Nigel, Bruce, David S., Carmody, Ian C., Joshi, Shoba, Reichman, Trevor W., Therapondos, George, Mason, Andrew L., Loss, George E.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.06.2013
• Subjects: Adult; Aged; DNA, Viral - isolation & purification; Female; Follow-Up Studies; Graft Survival; Hepatitis B - pathology; Hepatitis B - transmission; Hepatitis B Core Antigens - metabolism; Hepatitis B Surface Antigens - metabolism; Humans; Immunoglobulins - therapeutic use; Immunosuppressive Agents - therapeutic use; Lamivudine - therapeutic use; Liver - virology; Liver Failure - complications; Liver Failure - therapy; Liver Transplantation - methods; Male; Middle Aged; Time Factors; Tissue Donors; Treatment Outcome
• ISSN: 1527-6465; 1527-6473
• DOI: 10.1002/lt.23644

The use of livers from hepatitis B surface antigen–negative (HBsAg−)/hepatitis B core antibody–positive (HBcAb+) donors in liver transplantation (LT) for HBsAg−/HBcAb− recipients is still controversial because of a lack of standard antiviral prophylaxis and long‐term follow‐up. We present our 13‐year experience with the use of HBcAb+ donor livers in HBcAb− recipients. Patients received prophylaxis with hepatitis B immunoglobulin at the time of LT and then lamivudine daily. De novo hepatitis B virus (HBV) was defined as positive HBV DNA detection. Between January 1999 and December 2010, 1013 adult LT procedures were performed at our center. Sixty‐four HBsAg−/HBcAb− patients (6.3%) received an HBsAg−/HBcAb+ liver. All donor sera were negative for HBcAb immunoglobulin M and HBV DNA. The mean follow‐up was 48.8 ± 40.1 months (range = 1.2‐148.8). Both the patient survival rates and the graft survival rates were 92.2% and 69.2% at 1 and 5 years, respectively. No graft losses or deaths were related to de novo HBV. Nine of the 64 patients (14.1%) developed de novo HBV. The mean time from LT to de novo HBV was 21.4 ± 26.1 months (range = 10.8‐92.8 months). De novo HBV was successfully treated with adefovir or tenofovir. In conclusion, HBcAb+ allografts can be safely used in HBcAb− recipients without increased mortality or graft loss. Lifelong prophylaxis, continuous surveillance, and compliance are imperative for success. Should a de novo infection occur, our experience suggests that a variety of treatments can be employed to salvage the graft and obtain serum HBV DNA clearance. Liver Transpl 19:611–618, 2013. © 2013 AASLD.