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Abstract Details
Liver transplantation in hepatitis B core negative recipients using livers from hepatitis B core positive donor: 13 years experience
Bohorquez HE, Cohen AJ, Girgrah N, Bruce DS, Carmody IC, Joshi S, Reichman TW, Therapondos G, Mason AL, Loss GE. Liver Transpl. 2013 Mar 22. doi: 10.1002/lt.23644. [Epub ahead of print]
Source
Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA. hbohorquez@ochsner.org.
Abstract
Use of livers from hepatitis B (HBV) HBsAg (-) / HBc (+) donors in HBsAg (-) / HBc (-) recipients for liver transplantation (LT) is still controversial due to lack of standard antiviral prophylaxis and long-term follow-up. We present our 13 year experience using HBc (+) donor livers in HBc (-) recipients. Patients received prophylaxis with hepatitis B immunoglobulin (HBIG) at the time of LT and then lamivudine (LAM) daily. De-novo HBV was defined as positive HBV-DNA detection. Between January 1999 and December 2010, 1013 adult LT were performed in our center. Of them, 64 (6.3%) HBsAg (-)/HBc (-) patients received an HBsAg (-)/HBc (+) liver. All donor sera were negative for HBc IgM and HBV-DNA. Mean follow up was 48.8 + 40.1 months (Range 1- 148.8). Both patient and graft survival at 1 and 5 y were 92.18 and 69.2%. No graft loss or deaths were related to de-novo HBV. Nine of 64 (14.06%) patients developed de-novo HBV. Mean time from LT to de-novo HBV was 21.4 + 26.1 months (Range 10.8-92.8). De-novo HBV was successfully treated with adefovir or tenofovir. In conclusion, HBc (+) allografts can be safely used in HBc (-) recipients without increasing mortality or graft loss. Lifelong prophylaxis, continuous surveillance and compliance are imperative for success. Should de-novo infection occur, our experience suggests a variety of treatments may be employed to salvage the graft and obtain serum HBV-DNA clearance.