Use of hepatitis B core antibody-positive donors for liver transplantation

liver411

Liver Transplantation
October 2002, Supplement 1 . Volume 8 . Number 10

Session III-Hepatitis B

Use of hepatitis B core antibody-positive donors for liver transplantation

Santiago J. Muñoz

Abstract
1. Livers from donors previously exposed to hepatitis B virus (HBV) can fail
after transplantation as a result of severe HBV reactivation in the
transplant recipient.
2. Antibody against hepatitis B core antigen (HBcAb) in the donor is a
marker for risk for transmission of HBV and reactivation after liver
transplantation.
3. Recipient HBcAb positivity and antibody to hepatitis B surface antigen
(HBsAb) positivity are associated with less risk for HBV reactivation.
Conversely, the absence of HBcAb and/or HBsAb in the transplant recipient,
higher Child-Pugh score, and presence of HBV DNA in the donor liver may be risk factors for HBV reactivation in the transplant recipient.
4. Recipients of HBcAb-positive (HBcAb+) livers at high risk for HBV
reactivation should be treated prophylactically with lamivudine alone or a
combination of hepatitis B immunoglobulin (HBIg) and lamivudine. The value of monoprophylaxis with HBIg has not been established in this setting.
5. Until data from larger studies are available, for low-risk recipients of
HBcAb+ livers, no prophylaxis, with very close serological and virological
monitoring, appears to be a potential alternative to lamivudine
monoprophylaxis.
6. Recipients of HBcAb-negative livers should be investigated for HBV
infection when an episode of allograft dysfunction is not readily explained
by the usual causes (rejection, ischemia, or hepatitis C recurrence). (Liver
Transpl 2002;8:S82-S87.)

Publishing and Reprint Information

From the Division of Hepatology, Center for Liver Disease and Liver
Transplantation Program, Albert Einstein Medical Center, Philadelphia, PA.

Address reprint requests to Santiago J. Muñoz, MD, Head, Division of
Hepatology, Albert Einstein Medical Center, 5401 Old York Rd, Klein Bldg,
Ste 509, Philadelphia, PA 19141. Telephone: 215-456-8242; FAX: 215-456-8058;
E-mail: [email protected]

Copyright © 2002 by the American Association for the Study of Liver Diseases
1527-6465/02/0810-1004$35.00/0
doi:10.1053/jlts.2002.35783