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De novo hepatitis B after liver transplantation from hepatitis B core antibody—Positive donors in an area with high prevalence of anti‐HBc positivity in the donor population
Author(s) -
Prieto Martín,
Gómez María D.,
Berenguer Marina,
Córdoba Juan,
Rayón José M.,
Pastor Miguel,
GarcíaHerola Antonio,
Nicolás David,
Carrasco Domingo,
Orbis Juan F.,
Mir José,
Berenguer Joaquín
Publication year - 2001
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1053/jlts.2001.20786
Subject(s) - medicine , liver transplantation , hepatitis b , antibody , hepatitis c , population , transplantation , immunology , virology , gastroenterology , environmental health
Transmission of hepatitis B virus (HBV) infection from donors who are negative for hepatitis B surface antigen (HBsAg−) but positive for antibody to hepatitis B core antigen (anti‐HBc+) has been reported. However, previous studies were generally performed in geographic regions with a low prevalence of anti‐HBc positivity in the liver donor population. The aims of this study are (1) to assess the risk for de novo hepatitis B in recipients of livers from anti‐HBc+ donors in an area of high prevalence of anti‐HBc positivity in the donor population, and (2) to analyze the risk factors for acquisition of HBV infection from anti‐HBc+ donors. The transplantation experience of a single center between 1995 and 1998 was reviewed. Thirty‐three of 268 liver donors (12%) were HBsAg− and anti‐HBc+ during the study period. The proportion of anti‐HBc+ donors increased with age; it was lowest (3.6%) in donors aged 1 to 20 years and highest (27.1%) in donors aged older than 60 years. Of the 211 HBsAg− recipients with 3 months or more of HBV serological follow‐up, 30 received a liver from an anti‐HBc+ donor and 181 received a liver from an anti‐HBc− donor. Hepatitis B developed in 15 of 30 recipients (50%) of livers from anti‐HBc+ donors but in only 3 of 181 recipients (1.7%) of livers from anti‐HBc− donors ( P < .0001). None of the 4 recipients who were antibody to HBsAg (anti‐HBs)+ at the time of transplantation developed HBV infection after receiving a liver from an anti‐HBc+ donor compared with 15 of 26 recipients (58%) who were anti‐HBs− ( P = .10). None of the 5 anti‐HBc+ recipients developed hepatitis B compared with 15 of 25 anti‐HBc− recipients (60%; P = 0.04). Child‐Pugh score was significantly higher in recipients of livers from anti‐HBc+ donors who developed HBV infection than in those who did not (9 ± 2 v 7 ± 1; P = .03). In our area, testing liver donors for anti‐HBc is mandatory, particularly in older donors. With such information available, anti‐HBc+ donors can be safely directed to appropriate recipients, mainly those with anti‐HBs and/or anti‐HBc at the time of transplantation. In the current era of donor shortage, this policy would allow adequate use of such donors.