Prevention of de novo hepatitis B infection after liver transplantation with allografts from hepatitis B core antibody positive donors.

The frequent scarcity of organ donors has made it necessary to consider transplantation of organs that may have the potential to transmit hepatitis B virus (HBV) to the recipient. Previous reports have documented the probability of infection of particular recipient populations with transplanted livers from hepatitis B core antibody (anti-HBc) positive donors. Results have varied depending on the status of the recipients with respect to antibodies directed at the virus. Anti-HBc-positive and anti-HBs-positive recipients were generally resistant to hepatitis B infection, with the former infected at a low rate and the latter not at all. However, the probability of de novo HBV infection in naive recipients (anti-HBc-negative and anti-HBs-negative) was quite high (about 70%). The survival rate for infected patients is similar to those who are uninfected, but a significant percentage of infected patients will develop chronic hepatitis and a small percentage will develop allograft failure. Also reported here is a protocol designed to prevent the adverse consequences to naive recipients receiving livers from anti-HBc-positive donors. Hepatitis B immunoglobulin (HBIg) and lamivudine were utilized to prevent transmission of the hepatitis B virus. This combination has prevented de novo infections in all patients tested thus far. There are indications that HBIg or lamivudine may not be as effective when administered separately.