Utilization of hepatitis B core antibody positive grafts in living donor liver transplantation

Utilization of liver grafts from hepatitis B core antibody (anti-HBc) positive donors carries the risk of reactivation of hepatitis B virus (HBV) in recipients because of post-transplant immunosuppressive therapy.

This was a retrospective study of patients who had received liver grafts from anti-HBc positive live donors between 2006 and 2016 at our institute.

Out of 22 recipients [all males, mean age 45.4 years (range 18-64 years)], four patients were hepatitis B surface antigen (HBsAg) positive preoperatively and received entecavir post-transplantation. One among these patients who temporarily stopped entecavir had a recurrence of hepatitis B 39 months post-transplantation. Among the 13 non-immune [hepatitis B surface antibody (anti-HBs) < 10 mIU/mL] recipients, eight were prescribed lamivudine (100 mg daily) as monoprophylaxis. Four compliant patients remain negative for HBV so far. Out of the remaining four, two died secondary to sepsis unrelated to hepatitis B; two were non-compliant and developed reactivation of hepatitis B. Lamivudine was missed out in five non-immune patients; three of them developed hepatitis B reactivation while two remain negative. Anti-HBs titer was immune in five patients. Over a period of 4 to 8 years follow up, three remain immune without prophylaxis, while two expired due to causes unrelated to hepatitis B. Following the detection of hepatitis B infection, five patients have been started on tenofovir 300 mg once daily.

Anti-HBc positive liver grafts can be safely used for live donor liver transplantation. If the recipients are immune preoperatively, they can be merely followed up without HBV prophylaxis. However, it is extremely important to prophylactically treat the non-immune recipients with an antiviral agent lifelong.