title: Transmission of hepatitis B virus from hepatitis B core antibody-positive donors in living related liver transplants.
abstract: BACKGROUND
  In order to clarify the risk of hepatitis B virus (HBV) transmission from hepatitis B core antibody-positive (HBcAb(+)) donors and to evolve a new strategy to counter such a risk, we undertook a retrospective (1990-1995) and prospective (1995-1996) analysis of our experience with living related liver transplantation involving HBcAb(+) donors.
  
  
  METHODS
  Between June 15, 1990, and June 30, 1995, HBcAb(+) individuals were not excluded as donor candidates at our institutions. For 171 liver transplants, 16 donors were HBcAb(+). Between July 1, 1995, and June 30, 1996, HBcAb(+) individuals were generally excluded as donor candidates; however, three recipients were given liver grafts from HBcAb(+) donors because other donor candidates presented even higher risks. In the latter period, recipients with transplants from HBcAb(+) donors underwent prophylactic passive immunization with hyperimmune hepatitis B immunoglobulin (HBIG). The serum of 10 HBcAb(+) donors was examined by nested polymerase chain reaction for the presence of HBV-DNA, but it was not detected in any of them. However, the same examination of the liver tissue of five such donors yielded positive results in all cases.
  
  
  RESULTS
  In the first 5-year period, out of 16 recipients with HBcAb(+) donors, 15 became hepatitis B surface antigen-positive after transplant. The three recipients with HBcAb(+) donors during the second 1-year period, who were treated by prophylactic passive immunization with HBIG, remained hepatitis B surface antigen-negative and negative for serum HBV-DNA after transplant.
  
  
  CONCLUSIONS
  HBV exists in the liver of healthy HBcAb(+) individuals, but not in the blood. Therefore, HBV is thought to be transmitted to recipients by liver grafts from the HBcAb(+) donors at a significantly high rate. The prevention of viral activation and clinical disease development by means of passive immunization with HBIG seems promising, although the follow-up period in our study may be too short for any definitive conclusions.
authors.affiliation: Department of Transplantation Immunology, Faculty of Medicine, Kyoto University, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Uemoto
authors.forename: K
authors.initials: K
authors.lastname: Sugiyama
authors.forename: H
authors.initials: H
authors.lastname: Marusawa
authors.forename: Y
authors.initials: Y
authors.lastname: Inomata
authors.forename: K
authors.initials: K
authors.lastname: Asonuma
authors.forename: H
authors.initials: H
authors.lastname: Egawa
authors.forename: T
authors.initials: T
authors.lastname: Kiuchi
authors.forename: Y
authors.initials: Y
authors.lastname: Miyake
authors.forename: K
authors.initials: K
authors.lastname: Tanaka
authors.forename: T
authors.initials: T
authors.lastname: Chiba
mesh_terms: D004279:DNA, Viral / Q000032:analysis / Q000097:blood; D005190:Family; D006509:Hepatitis B / Q000635:transmission*; D006510:Hepatitis B Antibodies / Q000097:blood*; D006511:Hepatitis B Antigens / Q000097:blood*; D006512:Hepatitis B Core Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000302:isolation & purification*; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D016133:Polymerase Chain Reaction
chemical_list: D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006511:Hepatitis B Antigens; D006512:Hepatitis B Core Antigens