De novo hepatitis B infection acquired during liver transplantation

Although the use of donor organs from patients negative for hepatitis B surface antigen (HBsAg) but positive for hepatitis B core antibody (HBcAb) is well known to have the potential to transmit hepatitis B to the recipient, routine screening of organ donors for HBcAb is not yet implemented in the UK. We investigated whether current organ donor screening for hepatitis B infection is effective in preventing de novo hepatitis B infection after liver transplantation. The database of the liver transplant unit at the Queen Elizabeth Hospital, Birmingham, was searched for all cases of de novo hepatitis B after liver transplantation between January 1982 and July 2000. Four cases were identified from a population of 1354 (0.3%) adult liver transplant recipients. In all cases, the likely source of hepatitis B in the recipient was the donated organ. De novo acquisition of hepatitis B after liver transplantation occurs within the UK. This problem is likely to be resolved by the institution of HBcAb testing in all liver donors. Continuing the current practice in the UK of incomplete donor hepatitis B testing (HBsAg serology only) can no longer be justified. De novo acquired infection has potentially life-threatening implications to the liver recipient and their contacts.