Prevention of de novo hepatitis B infection after liver transplantation with allografts from hepatitis B core antibody positive donors.
The frequent scarcity of organ donors has made it necessary to consider transplantation of organs that may have the potential to transmit hepatitis B virus (HBV) to the recipient. Previous reports have documented the probability of infection of particular recipient populations with transplanted livers from hepatitis B core antibody (anti-HBc) positive donors. Results have varied depending on the status of the recipients with respect to antibodies directed at the virus. Anti-HBc-positive and anti-HBs-positive recipients were generally resistant to hepatitis B infection, with the former infected at a low rate and the latter not at all. However, the probability of de novo HBV infection in naive recipients (anti-HBc-negative and anti-HBs-negative) was quite high (about 70%). The survival rate for infected patients is similar to those who are uninfected, but a significant percentage of infected patients will develop chronic hepatitis and a small percentage will develop allograft failure. Also reported here is a protocol designed to prevent the adverse consequences to naive recipients receiving livers from anti-HBc-positive donors. Hepatitis B immunoglobulin (HBIg) and lamivudine were utilized to prevent transmission of the hepatitis B virus. This combination has prevented de novo infections in all patients tested thus far. There are indications that HBIg or lamivudine may not be as effective when administered separately.
Dodson
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SF
Thomas E. Starzl Transplantation Institute, University of Pittsburgh, PA 15213, USA.
D000998:Antiviral Agents / Q000627:therapeutic use; D004198:Disease Susceptibility; D006085:Graft Survival; D006509:Hepatitis B / Q000517:prevention & control* / Q000635:transmission; D006510:Hepatitis B Antibodies / Q000032:analysis*; D006512:Hepatitis B Core Antigens / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000821:virology; D006801:Humans; D007116:Immunization, Passive; D007136:Immunoglobulins / Q000008:administration & dosage; D019259:Lamivudine / Q000627:therapeutic use; D016031:Liver Transplantation; D011336:Probability; D015996:Survival Rate; D014019:Tissue Donors; D014184:Transplantation, Homologous
D000998:Antiviral Agents; D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D007136:Immunoglobulins; D019259:Lamivudine; C045213:hepatitis B hyperimmune globulin