ALLOGENEIC BONE-MARROW TRANSPLANTATION FROM HBSAG(- A MULTICENTER STUDY FROM THE GRUPPO-ITALIANO-TRAPIANTO-DI-MIDOLLO-OSSEO (GITMO)() DONORS )

Hepatitis B virus (HBV)-infected individuals are occasionally used as donors for bone marrow transplantation (BMT). We studied the rate of H BV infection and the clinical expression of the associated liver disea se in patients receiving marrow from HBsAg(+) donors. We performed a r etrospective survey in 14 BMT units in Italy in which all BMTs perform ed between 1984 and 1994 were reviewed and those involving HBsAg(+) do nors were identified. Donors and recipients were analyzed for HBV mark ers and liver disease. A total of 24 of 2,586 patients (0.9%) had rece ived an HBsAg(+) marrow. HBsAg became detectable in 22% of pre-BMT HBs Ag(-) patients, but only 5.5% became chronic HBsAg carriers. Antigenem ia developed more frequently in anti-HBs(-) compared with anti-HBs(+) patients independently of passive prophylaxis with hyperimmune anti-HB s Ig, although the difference was not significant. Severe liver failur e with death occurred in 21% of patients, which was a value greater th an that generally observed after BMT in our units (3.7%). Patients wit h an anti-HBe+ donor had higher frequency of liver failure (28% v0%) a nd alanine aminotransferase peaks as compared with those of patients w ith an HBeAg+ donor. Liver failure was not observed in anti-HBs(+) rec ipients. The use of HBsAg(+) donors, particularly if anti-HBe+, increa ses the risk of severe liver disease in BMI recipients. Anti-HBs posit ivity may prevent severe liver damage. (C) 1995 by The American Societ y of Hematology.