Use of aortic valve allografts from hepatitis B surface antigen-positive donors

Over a 28-month period, 31 patients undergoing aortic valve replacement received valve allografts from hepatitis B surface antigen-positive, hepatitis B e antigen-negative donors. At the time of operation, 22 recipients were immune to hepatitis B infection; 19 had antibodies to hepatitis B surface antigen, and 3 were hepatitis B surface antigen positive. Nine patients were regarded as being susceptible to hepatitis B; 7 lacked hepatitis B markers, and records of serological status could not be found for the other 2. Four of the susceptible patients received hepatitis B immunoglobulin postoperatively, and 1 of them also received one 10-micrograms dose of hepatitis B vaccine. The 9 susceptible patients underwent hepatitis B serological studies a mean of 17 months (range, 4 to 31 months) postoperatively. In only 1 patient, tested 29 months after operation, had antibodies to hepatitis B surface, hepatitis B core, and hepatitis B e antigens developed. He had not experienced a clinical episode of hepatitis, and results of liver function tests were normal. He had not received prophylaxis. Because hepatitis B virus may be transmitted by hepatitis B surface antigen-positive, hepatitis B e antigen-negative valves, prophylaxis should be given whenever they are used and follow-up serological studies undertaken.