Liver transplant from Anti-HBc-positive, HBsAg-negative donor into HBsAg-negative recipient: is it safe? A systematic review of the literature.
BACKGROUND
After liver transplant (LT) from Anti-HBc+/HBsAg- donors into HBsAg- recipients, transmission of hepatitis B virus (HBV) may occur (de novo HBV infection). This study analyzes the incidence of de novo HBV infection in HBsAg- recipients of Anti-HBc+/HBsAg- LT with respect to: (i) the recipients' HBV serology and (ii) the type of preventive therapy adopted.


METHODS
A systematic review of the literature using the electronic database Medline.


RESULTS
Five hundred and fifty-two LT in 36 articles were selected. Lamivudine, Hepatitis B immune globulin (HBIG), revaccination, and combined therapies were employed in multiple strategies as preventive interventions. Naïve recipients had a high risk of de novo HBV infection, with smaller incidences when HBIG and lamivudine were used, either alone or in association. Vaccinated recipients or those with isolated hepatitis B core antibodies (Anti-HBc) and previous HBV infection had lower risks of viral transmission, additionally reduced by any prophylaxis adoption.


CONCLUSIONS
LT from Anti-HBc+/HBsAg- donors into HBsAg- recipients is apparently safe, as long as the recipient is vaccinated or presents an isolated Anti-HBc or previous HBV infection and some prophylaxis is employed. Currently lamivudine seems the best alternative; other nucleoside analogs and revaccination strategies should be considered in future studies. Follow-up and preventive therapies should be maintained for five yr or preferably throughout the recipients' life span.
Avelino-Silva
Vivian Iida
VI
Division of Infectious and Parasitic Diseases, Clinics Hospital Department of Infectious and Parasitic Diseases, University of Sao Paulo Medical School, Sao Paulo, Brazil. viviansilva87@gmail.com
D'Albuquerque
Luiz Augusto Carneiro
LA
Bonazzi
Patrícia Rodrigues
PR
Song
Alice Tung Wan
AT
Miraglia
João Luiz
JL
De Brito Neves
Alan
A
Abdala
Edson
E
D006509:Hepatitis B / Q000276:immunology* / Q000517:prevention & control / Q000635:transmission; D006510:Hepatitis B Antibodies / Q000276:immunology*; D006514:Hepatitis B Surface Antigens / Q000276:immunology*; D006801:Humans; D016031:Liver Transplantation / Q000276:immunology*; D014019:Tissue Donors
D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens