PREVENTION OF DE NOVO HEPATITIS B INFECTION IN RECIPIENTS OF HEPATIC ALLOGRAFTS FROM ANTI-HBc POSITIVE DONORS

Background. The shortage of donor organs occasionally mandates the use of hepatic allografts from anti-HBc+ donors in recipients who are susceptible to de novo hepatitis B virus (HBV) infection. The efficacy of hepatitis B immune globulin and lamivudine to prevent de novo HBV infection in anti-HBs negative recipients of allografts from anti-HBc+ donors has not been investigated. Methods. After liver transplantation with an allograft from a donor positive for anti-HBc, recipients who were anti-HBs-, HbsAg- received hepatitis B immune globulin (HBIG) 10,000 IU i.v. daily for 7 days and monthly for 6 months. After 6 months, 1000 IU of HBIG was given IM. every 2 weeks for 18 months. Patients transplanted after 4/1/97 were given lamivudine 150 mg daily starting postoperative day 1. Results. Between 8/14/96 and 6/10/98, 264 orthotopic liver transplants were performed and 16 anti-HBs-, HbsAg- patients received an hepatic allograft from a donor positive for anti-HBc. HBIG mono-therapy was administered to one patient. HBIG and lamivudine combination therapy was administered to 15 patients. Of the 16 patients, 8 were positive only for anti-HBc before transplant, and 8 were naive (anti-HBs-, anti-HBc-). The single patient who received HBIG monotherapy became HbsAg+ at 6 months. All patients receiving combination therapy with HBIG and lamivudine have remained HbsAg-. The average follow-up is 459 days (range 170-754). Two patients died from unrelated causes. Conclusions. Combination therapy with HBIG and lamivudine may prevent de novo HBV infection in anti-HBs-, HbsAg- recipients of hepatic allografts from anti-HBc+ donors. (C) 1999 Lippincott Williams & Wilkins, Inc.; References: 1. Dodson SF, Issa S, Araya V, et al. Infectivity of hepatic allografts with antibodies to hepatitis B virus. Transplantation 1997; 64: 1582-1584. 2. Dickson RC, Everhart JE, Lake JR, et al. Transmission of hepatitis B by transplantation of livers from donors positive for antibody to hepatitis B core antigen. Gastroenterology 1997; 113: 1668-1674. 3. Wachs ME, Amend WJ, Ascher NL, et al. The risk of transmission of hepatitis B from HBsAg(-), HbcAb(+), HBIgM(-) organ donors. Transplantation 1995; 59: 230-234. 4. Lutwick LI, Sywassink JM, Corry RJ, Shorey JW. The transmission of hepatitis B by renal transplantation. Clin. Nephrol. 1983; 19: 317-319. 5. Douglas DD, Rakela J, Wright TL, Krom RAF, Wiesner RH. The clinical course of transplantation-associated de novo hepatitis B infection in the liver transplant recipient. Liver Transplantation and Surgery 1997; 3(2): 105-111. 6. Burbach GJ, Bienzle U, Neuhaus P, et al. Intravenous or intramuscular anti-HBs immunoglobulin for the prevention of hepatitis B reinfection after orthotopic liver transplantation. Transplantation 1997; 63: 478-480. 7. Sawyer RG, McGory RW, Gaffey MJ McCullough CC, Shephard BL, Houlgrave W, Ryan TS, Kuhns M, McNamara A, Caldwell SH, Abdulkareem A, Pruett TL. Improved clinical outcomes with liver transplantation for hepatitis B-induced chronic liver failure using passive immunization. Annals of Surgery 1998; 6: 841-850. 8. Lowell JA, Burgess S, Shenoy S Curci JA, Peters M, Howard TK. Mercury poisoning associated with high-dose hepatitis-B immune globulin administration after liver transplantation for chronic hepatitis B. Liver Transplantation and Surgery 1996; 2(6): 475-478. 9. Ling R, Mutimer D, Ahmed M, Boxall EH, Elias E, Dusheiko GM, Harrison TJ. Selection of mutations in the hepatitis B virus polymerase during therapy of transplant recipients with lamivudine. Hepatology 1996; 24: 711-713. 10. Turner DPJ, Zucherman M, Alexander GJM, Waite J, Wreghitt T. Risk of inappropriate exclusion of organ donors by introduction of hepatitis B core antibody testing. Transplantation 1997; 63: 775-777. 11. Brechot C, Degos F, Lugassy C, et al. Hepatitis B virus DNA in patients with chronic liver disease and negative tests fro hepatitis B surface antigen. N Engl J Med 1985; 312: 270-6. 12. Fong T, Govindarajan S, Valinluck B, et al. Status of hepatitis B virus DNA in alcoholic liver disease: a study of a large urban population in the United States. Hepatology 1988; 8: 1602-4. 13. Yokosuka O, Omata M, Imazeki F, et al. Hepatitis B virus RNA transcripts and DNA in chronic liver disease. N Engl J Med 1986; 315: 1187-92.