Use of hepatitis B core antibody-positive donors in orthotopic liver transplantation.

TitleUse of hepatitis B core antibody-positive donors in orthotopic liver transplantation.
Publication TypeJournal Article
Year of Publication2002
AuthorsHolt D, Thomas R, Van Thiel D, Brems JJ
Date Publisheddiscussion 575-6
ISSN0004-0010; 0004-0010
Accession Number11982471
KeywordsAdult, Aged, AIM, IM, Female, Hepatitis B / ep [Epidemiology], Hepatitis B / pc [Prevention & Control], Hepatitis B / tm [Transmission], Hepatitis B Antibodies / im [Immunology], Hepatitis B Core Antigens / im [Immunology], Humans, Immunization, Passive, Immunoglobulins / tu [Therapeutic Use], Incidence, Lamivudine / tu [Therapeutic Use], Liver Transplantation, Male, Middle Aged, Retrospective Studies, Tissue Donors, Transplantation, Homologous

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.

Alternate JournalArch.Surg.
Notify Library Reference ID1801

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