The clinical course of transplantation-associated de novo hepatitis B infection in the liver transplant recipient

✍ Scribed by Douglas, D D ;Rakela, J ;Wright, T L ;Krom, R A ;Wiesner, R H

• Publisher: Wiley (John Wiley & Sons)
• Year: 1997
• Tongue: English
• Weight: 159 KB
• Volume: 3
• Category: Article
• ISSN: 1074-3022
• DOI: 10.1002/lt.500030202

✦ Synopsis

Transmission of hepatitis B infection from hepatitis B surface antigen (HBsAg)-negative antibody to hepatitis B core (anti-HBc)-positive liver donors has been previously described. The longterm outcome of these transplant-associated de novo hepatitis B patients has not been well described and may affect future use of donor organs that are anti-HBc-positive. We describe the experience in our first 332 transplants, performed before exclusion of anti-HBc-positive liver donors. Nine of these 332 (3%) donors were anti-HBc positive. Three of these 9 (33%) recipients developed transplant-associated de novo hepatitis B infections compared with only 2 of 323 (0.5%) recipients who received anti-HBc-negative donor livers (P 5 .00014). Of our 9 recipients of anti-HBcpositive livers, 6 (67%) are alive, and no deaths or allograft failures have been related to complications of hepatitis B. Only 1 of 5 patients (20%) with de novo hepatitis B has developed significant graft dysfunction with an average follow-up of more than 7 years (range 63-124 months). The 1 recipient with allograft dysfunction related to de novo hepatitis B has significantly elevated viremia levels (average HBV DNA 460 pg/mL) compared with the other de novo hepatitis B recipients (average HBV DNA 23-58 pg/mL). In summary, anti-HBc-positive donors are more likely to transmit hepatitis B infections to recipients, but these de novo infections usually have a mild clinical course and do not seem to adversely affect longterm patient survival. Hepatitis B-related allograft dysfunction, when it occurs, is associated with higher levels of viral replication. With our current donor shortage, perhaps anti-HBc-positive donors could be used in very selected recipient populations.