Transplantation of livers from HBc Ab positive donors into HBc Ab negativerecipients: a strategy and preliminary results

Here we describe a strategy for using livers from hepatitis B core antibody (anti-HBc) positive donors in anti-HBc negative recipients and report our preliminary results. Adult anti-HBc negative recipients were immunized agai nst hepatitis B virus (HBV) prior to transplantation. Liver biopsies from a nti-HBc positive, HBs Ag negative donors were performed at the time of proc urement to rule out acute hepatitis or chronic liver disease. Donor serum a nd liver samples were collected for HBV DNA analysis by PCR. Recipients wer e given HBIG (10000 units, i.v.) during the anhepatic phase of transplantat ion. Patients were treated with lamivudine (150 mg) beginning on postoperat ive day (POD) 1. If HBV DNA was not detected in either donor liver or serum by PCR, recipient antiviral therapy was stopped. If donor liver and serum were positive for HBV DNA by PCR, the recipient was maintained on combinati on lamivudine and HBIG therapy. If HBV DNA was detected in donor liver but not in donor serum, the patient was managed on lamivudine therapy alone. Be tween February 1999 and June 2000, six anti-HBc negative recipients receive d liver transplants from anti-HBc positive donors. PCR analysis of serum fr om the six donors was negative for HBV DNA in each, while donor liver PCR a nalysis was positive in five of six for HBV DNA. Accordingly, all patients were given HBIG in the anhepatic phase of transplantation and five of six w ere maintained on daily lamivudine therapy. Follow-up periods have ranged f rom 2 to 18 months. There has been no emergence of de now hepatitis B. Seri al serum HBs Ag and HBV DNA assays have all proven negative. Moreover, whil e on lamivudine therapy, 2 patients now have undetectable HBV DNA in hepati c allograft biopsies by PCR analysis. Our strategy for using livers from an ti-H Be donors has yielded promising initial results. De novo hepatitis B h as not occurred and our data suggest residual hepatitis B virus may be erad icated in recipients maintained on lamivudine therapy.