Elsevier

Journal of Hepatology

Volume 52, Issue 2, February 2010, Pages 272-279
Journal of Hepatology

Review
Liver grafts from anti-hepatitis B core positive donors: A systematic review

https://doi.org/10.1016/j.jhep.2009.11.009Get rights and content
Under a Creative Commons license
open access

Background & Aims

Although hepatitis B virus (HBV) transmission after liver transplantation of grafts from HBsAg-negative, anti-HBc positive donors is well established, the growing organ shortage favours the use of such marginal grafts. We systematically evaluated the risk of HBV infection after liver transplantation with such grafts and the effect of anti-HBV prophylaxis.

Methods

We performed a literature review over the last 15 years identifying 39 studies including 903 recipients of anti-HBc positive liver grafts.

Results

Recurrent HBV infection developed in 11% of HBsAg-positive liver transplant recipients of anti-HBc positive grafts, while survival was similar (67–100%) to HBsAg-positive recipients of anti-HBc negative grafts. De novo HBV infection developed in 19% of HBsAg-negative recipients being less frequent in anti-HBc/anti-HBs positive than HBV naive cases without prophylaxis (15% vs 48%, p < 0.001). Anti-HBV prophylaxis reduced de novo infection rates in both anti-HBc/anti-HBs positive (3%) and HBV naive recipients (12%). De novo infection rates were 19%, 2.6% and 2.8% in HBsAg-negative recipients under hepatitis B immunoglobulin, lamivudine and their combination, respectively.

Conclusions

Liver grafts from anti-HBc positive donors can be safely used, preferentially in HBsAg-positive or anti-HBc/anti-HBs positive recipients. HBsAg-negative recipients should receive prophylaxis with lamivudine, while both anti-HBc and anti-HBs positive recipients may need no prophylaxis at all.

Abbreviations

HBV
hepatitis B virus
LT
liver transplantation
anti-HBc
HBV core antigen
HBsAg
hepatitis B surface antigen
cccDNA
covalently closed circular DNA
HBIG
hepatitis B immunoglobulin
LAM
lamivudine

Keywords

De novo HBV infection
Liver transplantation
Marginal donors
Anti-HBc positive donors
Hepatitis B immunoglobulin
Lamivudine
Vaccination

Cited by (0)