Liver transplant from Anti-HBc-positive, HBsAg-negative donor into HBsAg-negative recipient: is it safe? A systematic review of the literature
Article first published online: 28 APR 2010
© 2010 John Wiley & Sons A/S
Volume 24, Issue 6, pages 735–746, November/December 2010
How to Cite
Avelino-Silva, V. I., D′Albuquerque, L. A. C., Bonazzi, P. R., Song, A. T. W., Miraglia, J. L., De Brito Neves, A. and Abdala, E. (2010), Liver transplant from Anti-HBc-positive, HBsAg-negative donor into HBsAg-negative recipient: is it safe? A systematic review of the literature. Clinical Transplantation, 24: 735–746. doi: 10.1111/j.1399-0012.2010.01254.x
- Issue published online: 2 DEC 2010
- Article first published online: 28 APR 2010
- Accepted for publication 1 March 2010
- expanded donor pool;
- hepatitis B virus;
- liver transplant;
Avelino-Silva VI, D′Albuquerque LAC, Bonazzi PR, Song ATW, Miraglia JL, de Brito Neves A, Abdala E. Liver transplant from Anti-HBc-positive, HBsAg-negative donor into HBsAg-negative recipient: is it safe? A systematic review of the literature. Clin Transplant 2010: 24: 735–746. © 2010 John Wiley & Sons A/S.
Abstract: Introduction: After liver transplant (LT) from Anti-HBc+/HBsAg− donors into HBsAg− recipients, transmission of hepatitis B virus (HBV) may occur (de novo HBV infection). This study analyzes the incidence of de novo HBV infection in HBsAg− recipients of Anti-HBc+/HBsAg− LT with respect to: (i) the recipients’ HBV serology and (ii) the type of preventive therapy adopted.
Methods: A systematic review of the literature using the electronic database Medline.
Results: Five hundred and fifty-two LT in 36 articles were selected. Lamivudine, Hepatitis B immune globulin (HBIG), revaccination, and combined therapies were employed in multiple strategies as preventive interventions. Naïve recipients had a high risk of de novo HBV infection, with smaller incidences when HBIG and lamivudine were used, either alone or in association. Vaccinated recipients or those with isolated hepatitis B core antibodies (Anti-HBc) and previous HBV infection had lower risks of viral transmission, additionally reduced by any prophylaxis adoption.
Discussion: LT from Anti-HBc+/HBsAg− donors into HBsAg− recipients is apparently safe, as long as the recipient is vaccinated or presents an isolated Anti-HBc or previous HBV infection and some prophylaxis is employed. Currently lamivudine seems the best alternative; other nucleoside analogs and revaccination strategies should be considered in future studies. Follow-up and preventive therapies should be maintained for five yr or preferably throughout the recipients’ life span.