Transmission of hepatitis B infection from hepatitis B core antibody–positive liver allografts is prevented by lamivudine therapy

Authors

  • Andy S. Yu,

    1. Center for Liver Diseases and Transplantation, University of California at Los Angeles School of Medicine, Los Angeles, CA
    2. Burns and Allen Research Institute, University of California at Los Angeles School of Medicine, Los Angeles, CA
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  • John M. Vierling,

    1. Center for Liver Diseases and Transplantation, University of California at Los Angeles School of Medicine, Los Angeles, CA
    2. Burns and Allen Research Institute, University of California at Los Angeles School of Medicine, Los Angeles, CA
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  • Steven D. Colquhoun,

    1. Center for Liver Diseases and Transplantation, University of California at Los Angeles School of Medicine, Los Angeles, CA
    2. Burns and Allen Research Institute, University of California at Los Angeles School of Medicine, Los Angeles, CA
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  • Walid S. Arnaout,

    1. Center for Liver Diseases and Transplantation, University of California at Los Angeles School of Medicine, Los Angeles, CA
    2. Burns and Allen Research Institute, University of California at Los Angeles School of Medicine, Los Angeles, CA
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  • Chuek-Kee Chan,

    1. Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, University of California at Los Angeles School of Medicine, Los Angeles, CA
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  • Elham Khanafshar,

    1. Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, University of California at Los Angeles School of Medicine, Los Angeles, CA
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  • Stephen A. Geller,

    1. Burns and Allen Research Institute, University of California at Los Angeles School of Medicine, Los Angeles, CA
    2. Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, University of California at Los Angeles School of Medicine, Los Angeles, CA
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  • W. Stephen Nichols,

    1. Burns and Allen Research Institute, University of California at Los Angeles School of Medicine, Los Angeles, CA
    2. Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, University of California at Los Angeles School of Medicine, Los Angeles, CA
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  • Tse-Ling Fong

    MD, Corresponding author
    1. Center for Liver Diseases and Transplantation, University of California at Los Angeles School of Medicine, Los Angeles, CA
    2. Burns and Allen Research Institute, University of California at Los Angeles School of Medicine, Los Angeles, CA
    • Center for Liver Diseases and Transplantation, Cedars-Sinai Medical Center, 8635 West 3rd St, Ste 590W, Los Angeles, CA 90048. Telephone: 310-423-2641; FAX: 310-423-0234
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Abstract

Donor shortage has led to the use of hepatitis B core antibody (anti-HBc)-positive (anti-HBc+) liver allografts for patients in need of relatively urgent orthotopic liver transplantation (OLT). Because anti-HBc+ allografts transmit hepatitis B virus (HBV) infection at a high rate, effective prophylaxis is required. We assessed the effectiveness of lamivudine in preventing HBV transmission by anti-HBc+ allografts. Between March 1996 and March 2000 at Cedars-Sinai Medical Center (Los Angeles, CA), 15 of 169 patients (8.9%) received liver allografts from anti-HBc+ donors. Six patients were hepatitis B surface antigen (HBsAg)+ (group 1), and 9 patients were HBsAg negative (HBsAg; group 2) before OLT. All patients were administered lamivudine, 100 or 150 mg/d, orally after OLT. Patients who were HBsAg+ before OLT also were administered hepatitis B immunoglobulin (HBIG) prophylaxis. Hepatitis B serological tests were performed on all patients, and HBV DNA was determined in liver tissues in 10 patients. All 15 patients remained HBsAg at their last follow-up 2 to 40 months (mean, 17 months) post-OLT. All patients in group 1 had antibody to HBsAg (anti-HBs) titers greater than 250 mIU/mL post-OLT (mean follow-up, 20 months; range, 7 to 40 months). Of the 2 patients in group 1 who underwent liver biopsy after OLT, 1 patient had detectable hepatic HBV DNA despite being anti-HBs+ and HBsAg. Among the patients in group 2, none acquired anti-HBc or HBsAg. Hepatic HBV DNA was undetectable in the 7 patients in group 2 who underwent liver biopsy after OLT. Anti-HBc+ allografts can be safely used in patients who undergo OLT for chronic hepatitis B and susceptible transplant recipients if prophylaxis with combination HBIG and lamivudine or lamividine alone is administered after OLT, respectively. However, more data are needed to determine the efficacy of lamivudine monotherapy in preventing transmission of HBV infection from anti-HBc+ liver allografts to susceptible recipients.

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