Liver grafts from anti-hepatitis B core positive donors: a systematic review.
OBJECTIVE
Although hepatitis B virus (HBV) transmission after liver transplantation of grafts from HBsAg-negative, anti-HBc positive donors is well established, the growing organ shortage favours the use of such marginal grafts. We systematically evaluated the risk of HBV infection after liver transplantation with such grafts and the effect of anti-HBV prophylaxis.


METHODS
We performed a literature review over the last 15 years identifying 39 studies including 903 recipients of anti-HBc positive liver grafts.


RESULTS
Recurrent HBV infection developed in 11% of HBsAg-positive liver transplant recipients of anti-HBc positive grafts, while survival was similar (67-100%) to HBsAg-positive recipients of anti-HBc negative grafts. De novo HBV infection developed in 19% of HBsAg-negative recipients being less frequent in anti-HBc/anti-HBs positive than HBV naive cases without prophylaxis (15% vs 48%, p<0.001). Anti-HBV prophylaxis reduced de novo infection rates in both anti-HBc/anti-HBs positive (3%) and HBV naive recipients (12%). De novo infection rates were 19%, 2.6% and 2.8% in HBsAg-negative recipients under hepatitis B immunoglobulin, lamivudine and their combination, respectively.


CONCLUSIONS
Liver grafts from anti-HBc positive donors can be safely used, preferentially in HBsAg-positive or anti-HBc/anti-HBs positive recipients. HBsAg-negative recipients should receive prophylaxis with lamivudine, while both anti-HBc and anti-HBs positive recipients may need no prophylaxis at all.
Cholongitas
Evangelos
E
The Royal Free Sheila Sherlock Liver Centre and University, Department of Surgery, Royal Free Hospital, London, UK.
Papatheodoridis
George V
GV
Burroughs
Andrew K
AK
D000465:Algorithms; D000998:Antiviral Agents / Q000494:pharmacology; D006509:Hepatitis B / Q000276:immunology / Q000517:prevention & control / Q000635:transmission*; D006510:Hepatitis B Antibodies / Q000378:metabolism* / Q000627:therapeutic use; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens / Q000378:metabolism; D006801:Humans; D019259:Lamivudine / Q000494:pharmacology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000276:immunology; D012008:Recurrence; D012307:Risk Factors; D014019:Tissue Donors; D016896:Treatment Outcome
D000998:Antiviral Agents; D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D019259:Lamivudine