Prevention of de novo hepatitis B infection from HbcAb-positive donors in living donor liver transplantation

• Published in: Transplantation proceedings 2004-10, Vol.36 (8), p.2311-2312
• Main Authors: Lee, K.W., Lee, D.S., Lee, H.H., Kim, S.J., Joh, J.W., Seo, J.M., Choe, Y.H., Lee, S.K.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Child; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hepatitis B - prevention & control; Hepatitis B - transmission; Hepatitis B Core Antigens - blood; Hepatitis B Vaccines; Human viral diseases; Humans; Infectious diseases; Liver Transplantation; Living Donors; Medical sciences; Postoperative Complications - epidemiology; Postoperative Complications - virology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; Viral diseases; Viral hepatitis
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2004.08.139

Hepatitis B virus (HBV) prophylaxis is necessary to prevent de novo hepatitis B infection from HbcAb-positive donors. However, which protocol is more effective is somewhat controversial. Also, it is uncertain whether it is necessary to administer HBV prophylaxis for HbsAb-positive recipients. This study attempted to determine whether it is necessary to administer HBV prophylaxis for HbsAb-positive patients and to evaluate the efficacy of an HBIG monotherapy protocol. From May 1996 to July 2001, among 128 donors examined for HbcAb, 58 donors (45.3%) were HbcAb-positive. Eighteen HbcAb-positive grafts were transplanted to HbsAg-negative recipients. The 4 patients who died of unrelated causes were excluded from this study. Of 14 study cases, 12 recipients were HbsAb-positive, and 2 were HbsAb-naive. Prior to late 1998, we used HBV vaccination only for de novo infection prophylaxis. However, starting from December 1998, HBIG was administered from the time of the liver transplantation regardless of HBsAb positivity. The overall rate of de novo HBV infections from HbcAb-positive donors was 21.4% (3 of 14). All 3 recipients without HBIG prophylaxis presented with de novo HBV infections. Two were HbsAb-positive preoperatively. No de novo HBV infections occurred among recipients with HBIG prophylaxis. Therefore, it is essential to administer HBV prophylaxis even for vaccinated HbsAb-positive patients. HBIG monotherapy is effective to prevent de novo hepatitis B infections from HbcAb-positive donors in living donor liver transplantation.