engleski

Hepatitis B core antibody-positive donors in liver transplantation.

Introduction: The use of hepatitis B surface antigen (HBsAg) negative and hepatitis B core antibody (HBcAb) positive liver donors has expanded the donor pool. However, the antiviral prophylaxis (AP) in this setting still remains controversial due to a lack of long-term follow- up data. The aim of this study is to present our experience with HBcAb+ liver grafts. Methods: Retrospective analysis of adult HBcAb+ liver graft recipients from 6/2006 to 6/2006 at University Hospital Merkur. Results: In the study period, total of 856 liver transplantations (LT) were performed. 65 (7, 6%) recipients received HBsAg-/HBcAb+ graft, 10.8% of them were HBsAg+ (4.6% w/o HBsAg data). The majority of recipients (84.6%) were HBsAg- ; 74.5% HBV naive (HBsAg-/HBcAb-), 7.3% previously vaccinated (HBsAb+), 9.1% previously infected (HBsAb+/, HBcAb+), 5.5% only HBcAb+ (for 3.6% HBsAg- pts no HBsAb/HBcAb/ data was available). Of total HBsAg-/HBcAb+ graft recipients, 84.6% received an AP: 94.5% lamivudine (LAM), 3.6% tenofovir (TDF), 1.8% entecavir (ETV) (1 pt w/o AP data). Of 52 LAM recipients, 7.7% became HBsAg+, and 50% of them had HBV DNA breakthough > 2000 IU/mL. 75% of them were HBV naive. De novo HBV (DNHBV) infection was treated with LAM (1addition of adefovir, later TDF). All pts became HBV-DNA-. Of 9 recipients without the AP, 33.3% developed HBsAg+ with HBV DNA> 2000 IU/ml, of which 66.7% were HBV naive. 2 DNHBV pts treated with LAM became HBC-DNA negative and 1 pt is currently on ETV. 1- and 3-year patient and graft survivals were 86%, 80% and 83%, 77%, respectively. There was no grafts loss or death due to DNHBV. Conclusion: Antiviral lamivudine monoprophylaxis is successful and safe in prevention of DNHBV in majority of patients after LT during long-term follow-up. Lack of AP led to DNHBV in one third of patients. Thus, HBcAb positive liver grafts can be safely used without the increase of mortality and graft loss, but necessary long-term prophylaxis, patient compliance and careful patient monitoring are mandatory.

HBV core antibody positive donor ; liver transplantation

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