De novo hepatitis B infection acquired during liver transplantation

Summary: Although the use of donor organs from patients negative for hepatitis B surface antigen (HBsAg) but positive for hepatitis B core antibody (HBcAb) is well known to have the potential to transmit hepatitis B to the recipient, routine screening of organ donors for HBcAb is not yet implemented in the UK. We investigated whether current organ donor screening for hepatitis B infection is effective in preventing de novo hepatitis B infection after liver transplantation. The database of the liver transplant unit at the Queen Elizabeth Hospital, Birmingham, was searched for all cases of de novo hepatitis B after liver transplantation between January 1982 and July 2000. Four cases were identified from a population of 1354 (0.3%) adult liver transplant recipients. In all cases, the likely source of hepatitis B in the recipient was the donated organ. De novo acquisition of hepatitis B after liver transplantation occurs within the UK. This problem is likely to be resolved by the institution of HBcAb testing in all liver donors. Continuing the current practice in the UK of incomplete donor hepatitis B testing (HBsAg serology only) can no longer be justified. De novo acquired infection has potentially life-threatening implications to the liver recipient and their contacts. (C) Copyright Oxford University Press 2001.; References: 1. Radomski JS, Moritz MJ, Armenti VT, Munoz SJ. Hepatitis B transmission from a liver donor who tested negative for hepatitis B surface antigen and positive for hepatitis B core antibody. Liver Transpl Surg 1996; 2:130-1. 2. Douglas DD, Rakela J, Wright TL, Krom RA, Wiesner RH. The clinical course of transplantation-associated de novo hepatitis B infection in the liver transplant recipient. Liver Transpl Surg 1997; 3:105-11. 3. Todo S, Demetris AJ, Van Thiel D, Teperman L, Fung JJ, Starzl TE. Orthotopic liver transplantation for patients with hepatitis B virus-related liver disease. Hepatology 1991; 13:619-26. 4. O'Grady JG, Smith HM, Davies SE, Daniels HM, Donaldson PT, Tan KC, Portmann B, Alexander GJ, Williams R. Hepatitis B virus reinfection after orthotopic liver transplantation. Serological and clinical implications. J Hepatol 1992; 14:104-11. 5. Fabia R, Levy ME, Crippin J, Tillery W, Netto GJ, Aguanno J, Dysert P, Goldstein RM, Husberg BS, Gonwa TA, Klintmalm GB. De novo hepatitis B infection after liver transplantation: source of disease, incidence, and impact. Liver Transpl Surg 1998; 4:119-27. 6. Wachs ME, Amend WJ, Ascher NL, Bretan PN, Emond J, Lake JR, Melzer JS, Roberts JP, Tomlanovich SJ, Vincenti F. The risk of transmission of hepatitis B from HBsAg(-), HBcAb(+), HBIgM(-) organ donors. Transplantation 1995; 59:230-4. 7. Chalasani N, Smallwood G, Halcomb J, Fried MW, Boyer TD. Is vaccination against hepatitis B infection indicated in patients waiting for or after orthotopic liver transplantation? Liver Transpl Surg 1998; 4:128-32. 8. Uemoto S, Sugiyama K, Marusawa H, Inomata Y, Asonuma K, Egawa H, Kiuchi T, Miyake Y, Tanaka K, Chiba T. Transmission of hepatitis B virus from hepatitis B core antibody-positive donors in living related liver transplants. Transplantation 1998; 65:494-9. 9. Dodson SF, Bonham CA, Geller DA, Cacciarelli TV, Rakela J, Fung JJ. Prevention of de novo hepatitis B infection in recipients of hepatic allografts from anti-HBc positive donors. Transplantation 1999; 68:1058-61. 10. Dickson RC, Everhart JE, Lake JR, Wei Y, Seaberg EC, Wiesner RH, Zetterman RK, Pruett TL, Ishitani MB, Hoofnagle JH. Transmission of hepatitis B by transplantation of livers from donors positive for antibody to hepatitis B core antigen. The National Institute of Diabetes and Digestive and Kidney Diseases Liver Transplantation Database. Gastroenterology 1997; 113:1668-74. 11. Satterthwaite R, Ozgu I, Shidban H, Aswad S, Sunga V, Zapanta R Jr, Asai P, Bogaard T, Khetan U, Mendez RG, Mendez R. Risks of transplanting kidneys from hepatitis B surface antigen-negative, hepatitis B core antibody-positive donors. Transplantation 1997; 64:432-5.