title: Transmission of hepatitis B by transplantation of livers from donors positive for antibody to hepatitis B core antigen. The National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database.
abstract: OBJECTIVE
  Organ donors are a potential source of transmissible disease after transplantation. The aim of this study was to evaluate the risk of acquiring hepatitis B among transplantation recipients of livers from donors without serum hepatitis B surface antigen (HBsAg) but with antibody to hepatitis B core antigen (anti-HBc).
  
  
  METHODS
  The transplantation experience of four centers between 1989 and 1994 was reviewed. Recipients of livers from 674 donors were considered informative for hepatitis B virus transmission.
  
  
  RESULTS
  Hepatitis B developed in 18 of 23 recipients of livers from anti-HBc-positive donors (78%) compared with only 3 of 651 recipients of anti-HBc-negative donor livers (0.5%) (P < 0.0001). HBsAg persisted in all recipients with donor-related hepatitis B. Liver histology showed chronic hepatitis of moderate severity in 2 of 13 recipients at 1 year and 5 of 8 recipients between 1.6 and 4.5 years from transplantation. Liver transplantation from an anti-HBc-positive donor was associated with decreased 4-year survival (adjusted mortality hazard ratio of 2.4; 95% confidence interval, 1.4-4.0).
  
  
  CONCLUSIONS
  De novo posttransplantation hepatitis B infection occurs at a high rate in recipients of donors with anti-HBc. Transmission of hepatitis B through transplantation suggests that the virus may persist in the liver despite serological resolution of infection.
authors.affiliation: University of Virginia Health Sciences Center, Charlottesville, USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Dickson
authors.forename: J E
authors.initials: JE
authors.lastname: Everhart
authors.forename: J R
authors.initials: JR
authors.lastname: Lake
authors.forename: Y
authors.initials: Y
authors.lastname: Wei
authors.forename: E C
authors.initials: EC
authors.lastname: Seaberg
authors.forename: R H
authors.initials: RH
authors.lastname: Wiesner
authors.forename: R K
authors.initials: RK
authors.lastname: Zetterman
authors.forename: T L
authors.initials: TL
authors.lastname: Pruett
authors.forename: M B
authors.initials: MB
authors.lastname: Ishitani
authors.forename: J H
authors.initials: JH
authors.lastname: Hoofnagle
mesh_terms: D006509:Hepatitis B / Q000635:transmission*; D006510:Hepatitis B Antibodies / Q000097:blood*; D006512:Hepatitis B Core Antigens / Q000276:immunology*; D006514:Hepatitis B Surface Antigens / Q000276:immunology; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D014019:Tissue Donors
chemical_list: D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens