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Arch Surg. 2002 May;137(5):572-5; discussion 575-6.

Use of hepatitis B core antibody-positive donors in orthotopic liver transplantation.

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1
Department of Surgery, Loyola University Medical Center, Loyola University Stritch School of Medicine, Chicago, IL 60153, USA.

Abstract

HYPOTHESIS:

Hepatic allografts from donors positive for antibody to hepatitis B core antigen (anti-HBc) frequently transmit hepatitis B virus (HBV) infection to recipients. Therefore, most transplantation centers will not use these organs for orthotopic liver transplantation (OLT). Although it is expensive and not always efficacious, hepatitis B immune globulin (HBIG) has been used routinely for indefinite periods to prevent HBV infection in liver allograft recipients. We assessed the effectiveness of long-term use of a nucleoside analog, lamivudine, in preventing HBV transmission by anti-HBc-positive allografts.

DESIGN:

Retrospective study.

SETTING:

A tertiary care center.

PATIENTS:

Twelve patients received hepatic allografts from anti-HBc-positive donors at Loyola University Medical Center, Chicago, between February 23, 1998, and March 13, 2001.

INTERVENTION:

All patients received 10 000 U/d of intravenous HBIG for 7 days. In addition, they received 300 mg/d of lamivudine in divided doses. Their liver biopsy specimens were tested for HBV DNA, hepatitis B surface antigen (HBsAg), and hepatitis B core antibody (HBcAb). Serum samples from the donor and recipient were tested for HBcAb, HBV DNA, and hepatitis B surface antibody (HBsAb).

MAIN OUTCOME MEASURE:

The incidence of HBV infection in recipients who received HBcAb-positive donor livers and lamivudine prophylaxis.

RESULTS:

All recipients were anti-HBc negative before OLT. Five of the recipients had HBsAb titers greater than 150 U at the time of OLT. Three of the donor livers were HBV DNA positive and 2 were hepatitis B core antigen positive at the time of OLT. Donor serum was HBcAb positive in all 12 donors. None of the recipients have become infected with HBV with a follow-up of 2 to 38 months.

CONCLUSION:

Perioperative use of HBIG combined with long-term use of lamivudine can prevent HBV infection in recipients who receive hepatic allografts from HBcAb-positive donors.

PMID:
11982471
[Indexed for MEDLINE]
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