Expanded donor pool

Background. Since suitable recipients for hepatic allografts from donors with antibodies to hepatitis B virus (HBV) have not been determined, a review of our 7‐year experience with donors positive for hepatitis B surface antibody (anti‐HBs), hepatitis B core antibody (anti‐HBc), or both was undertaken. Methods. Recipients of hepatic allografts from donors with antibodies to HBV were identified by a retrospective review of procurement records and screened for HBV infection. Results. From January 1, 1990, to January 1, 1997, 2578 liver transplants were performed and 140 (5.4%) recipients received an allograft from a donor with antibodies to HBV. Twenty‐five of 48 recipients of a hepatic allograft from a donor positive only for anti‐HBs were screened and none developed HBV infection. Twenty‐five of 41 naive recipients of a hepatic allograft from an anti‐HBc positive donor were screened and 18/25 (72%) developed HBV infections. Four of these 18 naive recipients with HBV infection received an allograft from a donor positive for both anti‐HBc and anti‐HBs. Seven of 13 anti‐HBs‐positive recipients of an allograft from an anti‐HBc positive donor were screened and none developed HBV infection. Fifteen of 16 recipients positive only for anti‐HBc who received a hepatic allograft from an anti‐HBc‐positive donor were screened and 2/15 (13%) developed HBV infection. Conclusions. Hepatic allografts from donors positive only for anti‐HBs do not transmit HBV infection. Hepatic allografts from anti‐HBc‐positive donors frequently transmit HBV infection to naive recipients regardless of the donor anti‐HBs status, and antiviral prophylaxis may be indicated. Anti‐HBs‐positive recipients appear resistant to HBV infection after orthotopic liver transplantation with an allograft from an anti‐HBc‐positive donor. Recipients positive only for anti‐HBc infrequently develop HBV infection when transplanted with an allograft from an anti‐HBc‐positive donor; however, HBV prophylaxis may be justified.