title: Liver transplant from Anti-HBc-positive, HBsAg-negative donor into HBsAg-negative recipient: is it safe? A systematic review of the literature.
abstract: 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.
authors.affiliation: 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
authors.forename: Vivian Iida
authors.initials: VI
authors.lastname: Avelino-Silva
authors.forename: Luiz Augusto Carneiro
authors.initials: LA
authors.lastname: D'Albuquerque
authors.forename: Patrícia Rodrigues
authors.initials: PR
authors.lastname: Bonazzi
authors.forename: Alice Tung Wan
authors.initials: AT
authors.lastname: Song
authors.forename: João Luiz
authors.initials: JL
authors.lastname: Miraglia
authors.forename: Alan
authors.initials: A
authors.lastname: De Brito Neves
authors.forename: Edson
authors.initials: E
authors.lastname: Abdala
mesh_terms: 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
chemical_list: D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens