Liver transplantation from hepatitis B surface antigen positive donors: a safe way to expand the donor pool.
OBJECTIVE
The main limitation of orthotopic liver transplantation (OLT) is the scarcity of available donor organs. A possibility to increase the organ pool is to use grafts from hepatitis B virus surface antigen (HBsAg) positive donors, but few data are currently available in this setting. We assessed the clinical, serovirological, and immunological outcomes of liver transplant from HBsAg positive donors in a single centre study.


METHODS
From 2005 to 2009 10 patients underwent OLT from HBsAg positive donors, for HBV-related disease (n=6) or HBV-unrelated disease (n=4). The median follow-up was 42 months (range 12-60). All recipients were HBcAb positive and were given antiviral prophylaxis.


RESULTS
Patients transplanted for HBV-related disease never cleared HBsAg. Two HBsAg negative patients never tested positive for HBsAg, whereas the others experienced an HBsAg appearance, followed by spontaneous production of anti-HBs, allowing HBsAg clearance. No patient ever had any sign of HBV hepatitis. HBV replication was effectively controlled by antiviral therapy. The immunologic sub-study showed that a most robust anti-HBV specific T cell response was associated with the control of HBV infection.


CONCLUSIONS
OLT from HBsAg positive donors seems to be a safe procedure in the era of highly effective antiviral therapy.
Department of Clinical Medicine, University of Bologna, Bologna, Italy.
Elisabetta
E
Loggi
Lorenzo
L
Micco
Giorgio
G
Ercolani
Alessandro
A
Cucchetti
Florian K
FK
Bihl
Gian Luca
GL
Grazi
Stefano
S
Gitto
Andrea
A
Bontadini
Mauro
M
Bernardi
Paolo
P
Grossi
Alessandro Nanni
AN
Costa
Antonio Daniele
AD
Pinna
Christian
C
Brander
Pietro
P
Andreone
D000328:Adult; D000368:Aged; D000595:Amino Acid Sequence; D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006509:Hepatitis B / Q000188:drug therapy / Q000276:immunology / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000097:blood* / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000235:genetics / Q000276:immunology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016031:Liver Transplantation / Q000276:immunology / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D013601:T-Lymphocytes / Q000276:immunology; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome
D000998:Antiviral Agents; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D007166:Immunosuppressive Agents