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Use of Hepatitis B Core Antibody–Positive Donors in Orthotopic Liver Transplantation
Arch Surg. 2002;137:572-576.
Hypothesis Hepatic allografts from donors positive for antibody to hepatitis B core antigen (anti-HBc) frequently transmit hepatitis B virus (HBV) infection to recipients. Therefore, most transplantation centers will not use these organs for orthotopic liver transplantation (OLT). Although it is expensive and not always efficacious, hepatitis B immune globulin (HBIG) has been used routinely for indefinite periods to prevent HBV infection in liver allograft recipients. We assessed the effectiveness of long-term use of a nucleoside analog, lamivudine, in preventing HBV transmission by anti-HBc–positive allografts.
Design Retrospective study.
Setting A tertiary care center.
Patients Twelve patients received hepatic allografts from anti-HBc–positive donors at Loyola University Medical Center, Chicago, between February 23, 1998, and March 13, 2001.
Intervention All patients received 10 000 U/d of intravenous HBIG for 7 days. In addition, they received 300 mg/d of lamivudine in divided doses. Their liver biopsy specimens were tested for HBV DNA, hepatitis B surface antigen (HBsAg), and hepatitis B core antibody (HBcAb). Serum samples from the donor and recipient were tested for HBcAb, HBV DNA, and hepatitis B surface antibody (HBsAb).
Main Outcome Measure The incidence of HBV infection in recipients who received HBcAb-positive donor livers and lamivudine prophylaxis.
Results All recipients were anti-HBc negative before OLT. Five of the recipients had HBsAb titers greater than 150 U at the time of OLT. Three of the donor livers were HBV DNA positive and 2 were hepatitis B core antigen positive at the time of OLT. Donor serum was HBcAb positive in all 12 donors. None of the recipients have become infected with HBV with a follow-up of 2 to 38 months.
Conclusion Perioperative use of HBIG combined with long-term use of lamivudine can prevent HBV infection in recipients who receive hepatic allografts from HBcAb-positive donors.
From the Departments of Surgery (Drs Holt, Van Thiel, and Brems) and Medicine (Dr Van Thiel), Loyola University Medical Center, Stritch School of Medicine, Chicago, Ill. Mr Thomas is a medical student at Loyola University Medical Center, Stritch School of Medicine.
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