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Use of anti-HBc positive allografts in adult liver transplantation: toward a safer way to expand the donor pool.

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Donataccio, Dino Roggen, Francine De Reyck, Chantal Verbaandert, Catherine Bodéus, Monique [UCL] Lerut, Jan [UCL]

The use of livers from anti-hepatitis B core (HBc) positive donors can alleviate donor shortage. Nineteen of 367 (6%) adults receiving anti-HBc positive allografts [three were hepatitis B antigen (HBsAg) negative, hepatitis B antibody (HBsAb) positive; four were HBsAg positive and 12 were not exposed to hepatitis B viral (HBV) infection] were retrospectively reviewed. In HBsAg negative recipients, immunoprophylaxis (IP) was guided by viral serology and immunohistochemistry (IH) of day 0 and day 7 liver biopsies. If IH was negative, IP was stopped. None of three HBsAg negative, HBsAb positive recipients infected; one (replicating) of four HBsAg positive recipients reinfected and seven of eight (87.5%) HBsAg, HBsAb negative recipients, who did not receive long-term IP, infected after a median time of 2 years (range 1-5); one patient died of liver failure. Four HBsAg, HBsAb negative recipients, receiving life-long IP, remained infection free. Anti-HBc positive donor livers must be directed selectively first to HBsAg positive recipients, next to recipients having HBV antibodies and finally to HBV-naive recipients. Identification of both donor and recipient risk factors for HBV infection before transplantation allows indiscriminate use of antiviral prophylaxis. The necessity for IP therapy should be guided by HBV-DNA testing of donor liver tissue and serum. IH of early liver biopsies is an unreliable marker for predicting antiviral treatment requirements.

Document type Article de périodique (Journal article) – Journal Article, Research Support, Non-U.S. Gov't
Publication date 2006
Journal information "Transplant international : official journal of the European Society for Organ Transplantation" - Vol. 19, no. 1, p. 38-43 (2006)
Peer reviewed yes
issn 0934-0874
Publication status Publié
Affiliation UCL - MD/MIGE - Département de microbiologie, d'immunologie et de génétique
MESH Subject Adolescent ; Adult ; Biopsy ; Follow-Up Studies ; Hepatitis B - prevention & control - transmission ; Hepatitis B Core Antigens - analysis ; Hepatitis B Surface Antigens - analysis ; Humans ; Liver Transplantation - immunology - pathology ; Retrospective Studies ; Tissue Donors - statistics & numerical data ; Tissue and Organ Procurement - organization & administration ; Transplantation, Homologous - immunology ; Treatment Outcome
Links
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Bibliographic reference Donataccio, Dino ; Roggen, Francine ; De Reyck, Chantal ; Verbaandert, Catherine ; Bodéus, Monique ; et. al. Use of anti-HBc positive allografts in adult liver transplantation: toward a safer way to expand the donor pool.. In: Transplant international : official journal of the European Society for Organ Transplantation, Vol. 19, no. 1, p. 38-43 (2006)
Permanent URL http://hdl.handle.net/2078.1/10428