Singapore Med J. 2018 Sep 5. doi: 10.11622/smedj.2018104. [Epub ahead of print]
Understanding the hepatitis B core positive liver donor.
Kwan KWC1, Lim TR1, Kumar R1, Krishnamoorthy TL1.
Author information
1
Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
Abstract
The increasing number of patients on the Singapore national liver transplant waiting list and the lack of donor livers have necessitated a review on the limited use of marginal donor liver grafts. Some grafts are of good quality but are considered marginal due to positive donor antibody to hepatitis B virus core protein serology, and negative hepatitis B surface antigen (HBsAg) and hepatitis B DNA. The fear is of viral reactivation during periods of intense immunosuppression. This is made possible by the ability of the hepatitis B virion to reside in a dormant state within the hepatocyte nucleus despite HBsAg clearance, i.e. the occult hepatitis B infection (OBI). In truth, appropriate selection of recipients and effective post-transplantation immunoprophylaxis significantly reduce the risk of hepatitis B viral reactivation. This article explains the confusion surrounding OBI and reviews current recommendations on how to manage such donor liver grafts.
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