EXPANDED DONOR POOL

Background. Since suitable recipients for hepatic allografts from dono rs with antibodies to hepatitis B virus (HBV) have not been determined , a review of our 7-year experience with donors positive for hepatitis B surface antibody (anti-HBs), hepatitis B core antibody (anti-HBc), or both was undertaken. Methods. Recipients of hepatic allografts from donors with antibodies to Rev were identified by a retrospective revi ew of procurement records and screened for HBV infection. Results. Fro m January 1, 1990, to January 1, 1997, 2578 liver transplants were per formed and 140 (5.4%) recipients received an allograft from a donor wi th antibodies to HBV. Twenty-five of 48 recipients of a hepatic allogr aft from a donor positive only for anti-HBs were screened and none dev eloped HBV infection. Twenty-five of 41 naive recipients of a hepatic allograft from an anti-HBc positive donor were screened and 18/25 (72% ) developed HBV infections. Four of these 18 naive recipients with HBV infection received an allograft from a donor positive for both anti-H Bc and anti-HBs. Seven of 13 anti-HBs-positive recipients of an allogr aft from an anti-HBc positive donor were screened and none developed H BV infection. Fifteen of 16 recipients positive only for anti-HBc who received a hepatic allograft from an anti-HBc-positive donor were scre ened and 2/15 (13%) developed Rev infection. Conclusions. Hepatic allo grafts from donors positive only for anti-HBs do not transmit Rev infe ction. Hepatic allografts from anti-HBc-positive donors frequently tra nsmit HBV infection to naive recipients regardless of the donor anti-H Bs status, and antiviral prophylaxis may be indicated. Anti-HBs-positi ve recipients appear resistant to HBV infection after orthotopic liver transplantation with an allograft from an anti-HBc-positive donor. Re cipients positive only for anti-HBc infrequently develop HBV infection when transplanted with an allograft from an anti-HBc-positive donor; however, HBV prophylaxis may be justified.