title: Use of liver grafts from donors positive for antihepatitis B-core antibody (anti-HBc) in the era of prophylaxis with hepatitis-B immunoglobulin and lamivudine.
abstract: BACKGROUND
  The increasing demand for transplantation has resulted in a trend toward using virologically compromised donors. We reviewed our experience with liver grafts from hepatitis-B surface antigen (HBsAg)(-), antibody to core antigen (anti-HBc)(+) donors.
  
  
  METHODS
  Sixty-two liver transplants using HBsAg(-), anti-HBc(+) donors were studied. The decision to use prophylaxis was based on the presence or absence of donor and recipient risk factors for posttransplant hepatitis-B virus (HBV) transmission or reinfection. If the donor or recipient showed positive HBVDNA, hepatitis-B immunoglobulin (HBIg) and lamivudine were used. If both donor and recipient HBVDNA were negative, a choice between lamivudine and no prophylaxis was made on the basis of presence or absence of HBsAg and antibody to the surface antigen (anti-HBs) in the recipient.
  
  
  RESULTS
  No death or graft loss could be ascribed to HBV. Mild HBV infection occurred in two patients who were not taking the recommended prophylaxis. Among the other 60 patients, 1 showed positive e antigen (HBeAg) early after transplantation, and 2 (1 with recurrent cancer, 1 with HIV infection) showed HBsAg(+). None of the three patients had any other evidence of HBV infection. Forty-seven patients underwent liver biopsies. Changes consistent with hepatitis were observed in 26, and 24 had HCV infection; immunostains for HBV antigens were negative in all cases, and 7 showed positive HBVDNA.
  
  
  CONCLUSIONS
  A selective protocol based on donor and recipient risk factors for post-liver transplant HBV infection can prevent hepatitis-B infection and avoid unnecessary administration of antiviral prophylaxis in recipients of HBsAg(-), anti-HBc(+) liver allografts.
authors.affiliation: University of Miami School of Medicine, Department of Surgery, Division of Liver/GI Transplantation, Miami, FL, USA. jnery@med.miami.edu.
authors.forename: Jose R
authors.initials: JR
authors.lastname: Nery
authors.forename: Caio
authors.initials: C
authors.lastname: Nery-Avila
authors.forename: K Rajender
authors.initials: KR
authors.lastname: Reddy
authors.forename: Robert
authors.initials: R
authors.lastname: Cirocco
authors.forename: Deborah
authors.initials: D
authors.lastname: Weppler
authors.forename: David M
authors.initials: DM
authors.lastname: Levi
authors.forename: Seigo
authors.initials: S
authors.lastname: Nishida
authors.forename: Juan
authors.initials: J
authors.lastname: Madariaga
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Kato
authors.forename: Phillip
authors.initials: P
authors.lastname: Ruiz
authors.forename: Eugene
authors.initials: E
authors.lastname: Schiff
authors.forename: Andreas G
authors.initials: AG
authors.lastname: Tzakis
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival; D006509:Hepatitis B / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000032:analysis*; D006512:Hepatitis B Core Antigens / Q000276:immunology*; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use*; D019259:Lamivudine / Q000627:therapeutic use*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D007136:Immunoglobulins; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; C045213:hepatitis B hyperimmune globulin