Utilization of a liver allograft from a hepatitis B surface antigen positive donor.
With today's donor organ shortage, enhanced efforts must be made to utilize organs that previously would have been declined. We report a 26-year-old man with chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection who received a liver transplant from an HBsAg-positive donor. HBV viremia (6,281,185 copies/ml) was seen early posttransplant despite lamivudine prophylaxis, but became negative with addition of adefovir. Virologic analysis revealed predominantly donor HBV strain immediately posttransplant. At 5 months there was an elevation of liver enzymes accompanied by histologic evidence of hepatitis. At this time, HCV-RNA was positive but HBV DNA was undetectable. Treatment with pegylated interferon and ribavirin resulted in sustained clearance of HCV RNA. Two years posttransplant, the patient has normal liver biochemistry and HCV and HBV viral load are undetectable with persistence of HBsAg. Our experience suggests that with effective antiviral therapy, the use of HBsAg seropositive donors is feasible in selected circumstances.
Ho
Jin Kee
JK
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Harrigan
P Richard
PR
Sherlock
Christopher H
CH
Steinbrecher
Urs P
UP
Erb
Siegfried R
SR
Mo
Theresa
T
Chung
Stephen W
SW
Buczkowski
Andrezj K
AK
Intaraprasong
Pongphob
P
Scudamore
Charles H
CH
Yoshida
Eric M
EM
D000328:Adult; D002102:Cadaver; D016174:Hepacivirus / Q000302:isolation & purification; D006509:Hepatitis B / Q000188:drug therapy / Q000276:immunology* / Q000601:surgery / Q000821:virology; D006514:Hepatitis B Surface Antigens / Q000032:analysis* / Q000276:immunology; D006515:Hepatitis B virus / Q000201:enzymology / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D006526:Hepatitis C / Q000150:complications / Q000601:surgery / Q000821:virology; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D009154:Mutation / Q000235:genetics; D014019:Tissue Donors; D014184:Transplantation, Homologous
D006514:Hepatitis B Surface Antigens