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Antibodies to hepatitis B surface antigen prevent viral reactivation in recipients of liver grafts from anti-HBC positive donors
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  1. A M Roque-Afonso1,
  2. C Feray2,
  3. D Samuel2,
  4. D Simoneau1,
  5. B Roche2,
  6. J-F Emile3,
  7. M Gigou2,
  8. D Shouval2,
  9. E Dussaix1
  1. 1Laboratoire de Virologie, Hôpital Paul Brousse, Université Paris-Sud UPRES 1596, 12 avenue Paul Vaillant Couturier, 94804 Villejuif, France
  2. 2Centre Hépato-Biliaire, Institut National de la Santé et de la Recherche Médicale, No 9941, Hôpital Paul Brousse, Université Paris-Sud UPRES 1596, 12 avenue Paul Vaillant Couturier, 94804 Villejuif, France
  3. 3Laboratoire d'Anatomo-Pathologie, Hôpital Paul Brousse, Université Paris-Sud UPRES 1596, 12 avenue Paul Vaillant Couturier, 94804 Villejuif, France
  1. Correspondence to:
    A M Roque-Afonso, Laboratoire de Virologie, Hôpital Paul Brousse, Université Paris-Sud UPRES 1596, 12 avenue Paul Vaillant Couturier, 94804 Villejuif, France;
    anne-marie.roque{at}pbr-ap-hop-paris.fr

Abstract

Background and aims: Liver donors with serological evidence of resolved hepatitis B virus (HBV) infection (HBV surface antigen (HBsAg) negative, anti-HBV core (HBc) positive) can transmit HBV infection to recipients. In the context of organ shortage, we investigated the efficacy of hepatitis B immunoglobulin (HBIG) to prevent HBV infection, and assessed the infectious risk by polymerase chain reaction (PCR) testing for HBV DNA on serum and liver tissue of anti-HBc positive donors.

Patients: Between 1997 and 2000, 22 of 315 patients were transplanted with liver allografts from anti-HBc positive donors. Long term HBIG therapy was administered to 16 recipients. Four naive and two vaccinated patients received no prophylaxis.

Results: Hepatitis B developed in the four HBV naive recipients without prophylaxis and in none of the vaccinated subjects. Among the 16 recipients receiving HBIG, one patient with residual anti-HBs titres below 50 UI/ml became HBsAg positive. The remaining 15 remained HBsAg negative and HBV DNA negative by PCR testing throughout a 20 month (range 4–39) follow up period. HBV DNA was detected by PCR in 1/22 donor serum, and in 11/21 liver grafts with normal histology. A mean of 12 months post-transplantation (range 1–23) HBV DNA was no longer detectable in graft biopsies from patients remaining HBsAg negative.

Conclusion: Anti-HBs antibodies may control HBV replication in liver grafts from anti-HBc positive donors, without additional antiviral drugs. These grafts are thus suitable either to effectively vaccinated recipients or to those who are given HBIG to prevent HBV recurrence.

  • hepatitis B virus
  • anti-hepatitis B virus core
  • liver transplantation
  • hepatitis B virus infection
  • liver grafts
  • HBV, hepatitis B virus
  • HBc, HBV core
  • HBsAg, HBV surface antigen
  • HBeAg, HBV e antigen
  • HBIG, HBV immunoglobulin
  • PCR, polymerase chain reaction
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