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The clinical course of transplantation‐associated de novo hepatitis B infection in the liver transplant recipient
Ist Teil von
Liver Transplantation and Surgery, 1997-03, Vol.3 (2), p.105-111
Ort / Verlag
Philadelphia, PA: W.B. Saunders
Erscheinungsjahr
1997
Link zum Volltext
Quelle
MEDLINE
Beschreibungen/Notizen
Transmission of hepatitis B infection from hepatitis B surface antigen (HBsAg)–negative antibody to hepatitis B core (anti‐HBc)–positive liver donors has been previously described. The long‐term outcome of these transplant‐associated de novo hepatitis B patients has not been well described and may affect future use of donor organs that are anti‐HBc–positive. We describe the experience in our first 332 transplants, performed before exclusion of anti‐HBc–positive liver donors. Nine of these 332 (3%) donors were anti‐HBc positive. Three of these 9 (33%) recipients developed transplant‐associated de novo hepatitis B infections compared with only 2 of 323 (0.5%) recipients who received anti‐HBc–negative donor livers (P = .00014). Of our 9 recipients of anti‐HBc–positive livers, 6 (67%) are alive, and no deaths or allograft failures have been related to complications of hepatitis B. Only 1 of 5 patients (20%) with de novo hepatitis B has developed significant graft dysfunction with an average follow‐up of more than 7 years (range 63‐ 124 months). The 1 recipient with allograft dysfunction related to de novo hepatitis B has significantly elevated viremia levels (average HBV DNA 460 pg/mL) compared with the other de novo hepatitis B recipients (average HBV DNA 23‐58 pg/mL). In summary, anti‐HBc–positive donors are more likely to transmit hepatitis B infections to recipients, but these de novo infections usually have a mild clinical course and do not seem to adversely affect long‐term patient survival. Hepatitis B‐related allograft dysfunction, when it occurs, is associated with higher levels of viral replication. With our current donor shortage, perhaps anti‐HBc–positive donors could be used in very selected recipient populations.