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

StephenW

J Hepatol. 2009 Dec 22. [Epub ahead of print]

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

Cholongitas E, Papatheodoridis GV, Burroughs AK.

The Royal Free Sheila Sherlock Liver Centre and University, Department of
Surgery, Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG, UK.


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 15years 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.
Copyright © 2009 European Association for the Study of the Liver. Published
by Elsevier B.V. All rights reserved.