Understanding the hepatitis B core positive liver donor

Area of Science:

• Hepatology
• Transplantation Immunology
• Virology

Background:

• Singapore faces a growing liver transplant waiting list and donor liver shortage.
• Marginal donor liver grafts, including those with occult hepatitis B infection (OBI), are underutilized.
• OBI is characterized by negative HBsAg and HBV DNA but positive anti-HBc, with potential for viral reactivation.

Purpose of the Study:

• To review the current understanding and management of OBI in donor liver grafts.
• To address the confusion surrounding OBI and its implications for liver transplantation.
• To provide recommendations for managing marginal donor liver grafts in the context of OBI.

Main Methods:

• Review of existing literature on occult hepatitis B infection.
• Analysis of risks associated with hepatitis B viral reactivation in transplant recipients.
• Examination of current immunoprophylaxis strategies post-liver transplantation.

Main Results:

• The hepatitis B virus can remain dormant in hepatocytes, leading to OBI.
• The risk of viral reactivation in OBI donor grafts is manageable.
• Effective recipient selection and post-transplant immunoprophylaxis significantly reduce reactivation risk.

Conclusions:

• Marginal donor liver grafts with OBI can be safely utilized in liver transplantation.
• Current management strategies effectively mitigate the risk of hepatitis B viral reactivation.
• A revised approach to utilizing these grafts can help address donor liver shortages.