Influence of anti-HBc positive organ donor in lung donor selection.
BACKGROUND
The risk of hepatitis B virus (HBV) transmission through donor organs with HBsAg(-) and anti-HBc(+) serology has not been extensively studied in lung transplantation. The objectives of this study are to ascertain the influence of the anti-HBc(+) on the acceptance of the lung for transplantation, to comment on the published literature and to suggest an algorithm for action.


METHODS
A survey conducted in the 7 Spanish lung transplantation teams. The updated search of the literature was performed using medical databases from 1994 to February 2012.


RESULTS
All of the teams vaccinate the lung recipients against HBV, although none quantify the anti-HBs titers. When given an anti-HBc(+) donor, 3 teams change their strategy: one does not accept the offer, one selects the receptor from among patients in emergency status and another adds pharmacological prophylaxis. Only 3 publications refer to the serologic evolution of the receptors. At the moment there have been no reported cases of hepatitis B or HBsAg positivity post-transplant, but 4 out of the 50 anti-HBc(-) receptors changed to anti-HBc(+) in the follow-up.


CONCLUSIONS
The presence of anti-HBc in the donor influences the decision to accept a lung donor, although there is little information on its repercussions. To date, there has been no reported case of transmission of HBV, but post-transplant anti-HBc seroconversions have been described, which suggests contact with viral particles. Although rare, an anti-HBc(+) donor can harbor a hidden HBV infection. The risk of infection can be reduced with adequate anti-HBs titers or with appropriate pharmacological measures.
Oficina Regional de Trasplantes de la Comunidad de Madrid, Madrid, España. carlos.chamorroj@salud.madrid.org
Carlos
C
Chamorro
Manuel
M
Aparicio
D000998:Antiviral Agents / Q000627:therapeutic use; D046148:Donor Selection / Q000592:standards*; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006509:Hepatitis B / Q000517:prevention & control* / Q000635:transmission; D006510:Hepatitis B Antibodies / Q000097:blood*; D006512:Hepatitis B Core Antigens / Q000097:blood* / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage; D006515:Hepatitis B virus / Q000276:immunology; D006801:Humans; D007258:Informed Consent; D019259:Lamivudine / Q000008:administration & dosage; D016040:Lung Transplantation / Q000009:adverse effects / Q000592:standards; D016134:Organizational Policy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011300:Preoperative Care; D013030:Spain; D014019:Tissue Donors; D014611:Vaccination / Q000706:statistics & numerical data; D005719:gamma-Globulins / Q000008:administration & dosage
D000998:Antiviral Agents; D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D005719:gamma-Globulins; D019259:Lamivudine