Hepatitis B Prophylaxis in Hepatitis B–Negative Recipients Transplanted With Donor Grafts Positive for Hepatitis B Core Antibodies

• Published in: Transplantation proceedings Vol. 43; no. 1; pp. 271 - 273
• Main Authors: Scuderi, V, Ceriello, A, Santaniello, W, Aragiusto, G, Romano, M, Migliaccio, C, Calise, F
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 2011; Elsevier
• Subjects: Adolescent; Adult; Aged; Antiviral Agents - administration & dosage; Biological and medical sciences; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hepatitis B - drug therapy; Hepatitis B - prevention & control; Hepatitis B Antibodies - immunology; Hepatitis B Core Antigens - immunology; Human viral diseases; Humans; Infectious diseases; Lamivudine - administration & dosage; Liver Transplantation; Male; Medical sciences; Middle Aged; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue Donors; Tissue, organ and graft immunology; Viral diseases; Viral hepatitis; Young Adult; Suboptimal donor; Human; Graft(material); B-Blood group; Antibody; Hepatic disease; Transplantation; Homotransplantation; Infection; Viral hepatitis B; Medicine; Prevention; Treatment; Viral disease; Surgery; Digestive diseases; Graft
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2010.09.100

Abstract Background and aims Use of grafts from hepatitis B (HBV) core antibody (HBcAb+ ) individuals is a routine transplant practice. Herein, we have reported the results of 20 HBV-negative patients transplantated with a HBcAb-positive liver grafts in order to access the efficacy of HBV prophylaxis using immunoglobulin (IE) and antiviral drugs. Methods From January 2004 to December 2009, we performed 168 liver transplantations including 38 HBcAb-positive grafts (22.6%) in 18 cases of HBV-positive recipients and 20 HBV-negative recipients. Histological data obtained from these last 20 grafts during retrieval showed an Ishak 1 score in three and no fibrosis in the other cases. HBV prophylaxis included infusion of 10,000 UI IG during the anhepatic phase and every 24 hours for the first 7 days irrespective of the antibody titer as well as lamivudin (100 mg) administred daily. Once discharged, outpatient management provided modulated IG infusions according to when the antibody titer was lower than 400 UI. Results No patient displayed an HBV infection. The overall survival was 80%. Two patients died within the first month after transplantation due to septic complications; one patient succumbed at 24 months after transplantation because of a lymphoproliferative malignancy and another died due to an aggressive hepatitis C virus recurrence at 6 months post transplant. Conclusion By using appropriate anti-HBV prophylaxis, HBcAb-positive grafts can be used safely for HBcAb-negative recipients.