title: Liver transplantation in hepatitis B core-negative recipients using livers from hepatitis B core-positive donors: a 13-year experience.
abstract: The use of livers from hepatitis B surface antigen-negative (HBsAg- )/hepatitis B core antibody-positive (HBcAb+ ) donors in liver transplantation (LT) for HBsAg(-) /HBcAb- recipients is still controversial because of a lack of standard antiviral prophylaxis and long-term follow-up. We present our 13-year experience with the use of HBcAb+ donor livers in HBcAb- recipients. Patients received prophylaxis with hepatitis B immunoglobulin at the time of LT and then lamivudine daily. De novo hepatitis B virus (HBV) was defined as positive HBV DNA detection. Between January 1999 and December 2010, 1013 adult LT procedures were performed at our center. Sixty-four HBsAg- /HBcAb- patients (6.3%) received an HBsAg- /HBcAb+ liver. All donor sera were negative for HBcAb immunoglobulin M and HBV DNA. The mean follow-up was 48.8 ± 40.1 months (range = 1.2-148.8). Both the patient survival rates and the graft survival rates were 92.2% and 69.2% at 1 and 5 years, respectively. No graft losses or deaths were related to de novo HBV. Nine of the 64 patients (14.1%) developed de novo HBV. The mean time from LT to de novo HBV was 21.4 ± 26.1 months (range = 10.8-92.8 months). De novo HBV was successfully treated with adefovir or tenofovir. In conclusion, HBcAb+ allografts can be safely used in HBcAb- recipients without increased mortality or graft loss. Lifelong prophylaxis, continuous surveillance, and compliance are imperative for success. Should a de novo infection occur, our experience suggests that a variety of treatments can be employed to salvage the graft and obtain serum HBV DNA clearance.
authors.affiliation: Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA 70121, USA. hbohorquez@ochsner.org
authors.forename: Humberto E
authors.initials: HE
authors.lastname: Bohorquez
authors.forename: Ari J
authors.initials: AJ
authors.lastname: Cohen
authors.forename: Nigel
authors.initials: N
authors.lastname: Girgrah
authors.forename: David S
authors.initials: DS
authors.lastname: Bruce
authors.forename: Ian C
authors.initials: IC
authors.lastname: Carmody
authors.forename: Shoba
authors.initials: S
authors.lastname: Joshi
authors.forename: Trevor W
authors.initials: TW
authors.lastname: Reichman
authors.forename: George
authors.initials: G
authors.lastname: Therapondos
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Mason
authors.forename: George E
authors.initials: GE
authors.lastname: Loss
mesh_terms: D000328:Adult; D000368:Aged; D004279:DNA, Viral / Q000302:isolation & purification; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006509:Hepatitis B / Q000473:pathology / Q000635:transmission*; D006512:Hepatitis B Core Antigens / Q000378:metabolism; D006514:Hepatitis B Surface Antigens / Q000378:metabolism; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D019259:Lamivudine / Q000627:therapeutic use; D008099:Liver / Q000821:virology; D017093:Liver Failure / Q000150:complications / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D004279:DNA, Viral; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D007136:Immunoglobulins; D007166:Immunosuppressive Agents; D019259:Lamivudine; C045213:hepatitis B hyperimmune globulin