Anti-HBs re-seroconversion after liver transplantation in a patient with past HBV infection receiving a HBsAg positive graft

• Published in: Journal of hepatology Vol. 50; no. 3; pp. 625 - 630
• Main Authors: Loggi, Elisabetta, Bihl, Florian, Chisholm, John V, Biselli, Maurizio, Bontadini, Andrea, Vitale, Giovanni, Ercolani, Giorgio, Grazi, Gian Luca, Pinna, Antonio D, Bernardi, Mauro, Brander, Christian, Andreone, Pietro
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier B.V 01.03.2009; Elsevier
• Subjects: Antibody Formation; Biological and medical sciences; Epitopes - analysis; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; HBsAg positive marginal graft; Hepatitis B - immunology; Hepatitis B - surgery; Hepatitis B Surface Antigens - analysis; Hepatitis B virus - genetics; Hepatitis B virus - immunology; Hepatitis B virus - isolation & purification; Hepatorenal Syndrome - surgery; Human viral diseases; Humans; Humoral immunity; Immunity, Cellular; Infectious diseases; Liver - virology; Liver Transplantation - immunology; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Organ shortage; Orthotopic liver transplantation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; T cell immunity; Tissue Donors; Viral diseases; Viral hepatitis; ESLD; hepatitis B virus; alanine aminotransferase; enzyme-linked immunospot; ALT; ELISpot; Organ shortage; end-stage liver disease; hepatitis B immunoglobulin; OLT; HBsAg positive marginal graft; hepatitis C virus; T cell immunity; HBIG; HCV; HBV; orthotopic liver transplantation; Humoral immunity; Orthotopic liver transplantation; Human; Hepatitis B surface antigen; Hepatic disease; Infection; Viral hepatitis B; Immunological investigation; Viral disease; Gastroenterology; T-Lymphocyte; Digestive diseases; Graft; Organ; Liver transplantation
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/j.jhep.2008.08.026

Background/Aims Orthotopic liver transplantation (OLT) is an important therapeutic option for HBV-related end-stage-liver disease, yet it is often hampered by a scarcity of organ availability. One option to increase organ availability is the use of virologically compromised organs from HBV-infected donors. Transplantation of anti-HBcore positive grafts has been associated with a low risk of HBV recurrence if adequately treated with nucleoside analogs, irrespective of concomitant HBV-specific immunoglobulin therapy. Experience using HBsAg positive grafts is, however, very limited. Methods Here, the analysis of the cellular and humoral HBV-specific immunity of a subject with past HBV infection (anti-HBs and anti-HBc positive) receiving an HBsAg positive liver graft is reported. Results Nine months post-OLT, the patient experienced a spontaneous anti-HBs re-seroconversion allowing the discontinuation of HBIG. The data show a concurrent increase in the cellular and humoral immunity at times of reduced viral antigenemia, demonstrating effective immune control of HBV post-OLT. Conclusions These data support the use of marginal organs in this setting, providing a potential strategy to further alleviate organ shortage.