TRANSMISSION OF HEPATITIS-B VIRUS FROM HEPATITIS-B CORE ANTIBODY-POSITIVE DONORS IN LIVING-RELATED LIVER-TRANSPLANTS

Background. In order to clarify the risk of hepatitis B virus (HBV) tr ansmission from hepatitis B core antibody-positive (HBcAb(+)) donors a nd to evolve a new strategy to counter such a risk, we undertook a ret rospective (1990-1995) and prospective (1995-1996) analysis of our exp erience with living related liver transplantation involving HBcAb(+) d onors. Methods. Between June 15, 1990, and June 30, 1995, HBcAb(+) ind ividuals were not excluded as donor candidates at our institutions, Fo r 171 liver transplants, 16 donors were HBcAb(+), Between July 1, 1995 , and June 30, 1996, HBcAb(+) individuals were generally excluded as d onor candidates; however, three recipients were given liver grafts fro m HBcAb(+) donors because other donor candidates presented even higher risks, In the latter period, recipients with transplants from HBcAb() donors underwent prophylactic passive immunization with hyperimmune hepatitis B immunoglobulin (HBIG). The serum of 10 HBcAb(+) donors was examined by nested polymerase chain reaction for the presence of HBV- DNA, but it was not detected in any of them, However, the same examina tion of the liver tissue of five such donors yielded positive results in all cases. Results. In the first 5-year period, out of 16 recipient s with HBcAb(+) donors, 15 became hepatitis B surface antigen-positive after transplant, The three recipients with HBcAb(+) donors during th e second 1-year period, who were treated by prophylactic passive immun ization with HBIG, remained hepatitis B surface antigen-negative and n egative for serum HBV-DNA after transplant. Conclusions. HBV exists in the liver of healthy HBcAb(+) individuals, but not in the blood, Ther efore, HBV is thought to be transmitted to recipients by liver grafts from the HBcAb(+) donors at a significantly high rate, The prevention of viral activation and clinical disease development by means of passi ve immunization with HBIG seems promising, although the follow-up peri od in our study may be too short for any definitive conclusions.