A case-controlled study on the use of HBsAg-positive donors for allogeneichematopoietic cell transplantation

To compare the clinical and serological outcomes of patients receiving dono rs' marrow positive or negative for hepatitis B surface antigen (HBsAg), we studied 18 patients of allogeneic hematopoietic cell transplantation recei ving HBsAg-positive marrow (group 1) and 18 receiving HBsAg-negative marrow (group 2), The recipients of the 2 groups were matched for hepatitis B vir us (HBV) serology, sex, age, underlying hematological diseases, conditionin g regimen, and prophylaxis against graft-versus-host diseases. Eight (44.4% ) recipients in group 1 and 2 (11.1%) in group 2 suffered from HBV-related hepatitis posttransplant (P =.03), Furthermore, HBV-related hepatic failure was seen in 6 group 1 patients, but in none of the group 2 patients (P =.0 07), Five of the 9 (55.5%) HBsAg-negatlve recipients in group 1 became posi tive after receiving HBsAg-positive marrow, Serum HBV DNA was positive in a ll 5 donors of these patients, but in none of the donors of recipients who remained HBsAg negative (P =.008), Group 1 patients developing HBV-related hepatitis posttransplant were more likely to have a donor carrying a precor e A(1896) and/or core promoter T-1762/A(1764) HBV variant (62.5% versus 0%, P =.007). This study has demonstrated that a high incidence of HBV-related hepatitis was associated with the use of HBsAg-positive marrow for transpl ant, and a high viral load in the donor appeared to predispose recipients t o the development of HBV-related hepatitis posttransplant. further clinical trials will be necessary to determine the optimal management approach to t his problem, including the use of the antiviral agents in the donors and th e recipients. (C) 2000 by The American Society of Hematology.