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Abstract
Although hepatitis B virus (HBV) transmission after liver transplantation of grafts
from HBsAg-negative, anti-HBc positive donors is well established, the growing organ
shortage favours the use of such marginal grafts. We systematically evaluated the
risk of HBV infection after liver transplantation with such grafts and the effect
of anti-HBV prophylaxis.
We performed a literature review over the last 15 years identifying 39 studies including
903 recipients of anti-HBc positive liver grafts.
Recurrent HBV infection developed in 11% of HBsAg-positive liver transplant recipients
of anti-HBc positive grafts, while survival was similar (67-100%) to HBsAg-positive
recipients of anti-HBc negative grafts. De novo HBV infection developed in 19% of
HBsAg-negative recipients being less frequent in anti-HBc/anti-HBs positive than HBV
naive cases without prophylaxis (15% vs 48%, p<0.001). Anti-HBV prophylaxis reduced
de novo infection rates in both anti-HBc/anti-HBs positive (3%) and HBV naive recipients
(12%). De novo infection rates were 19%, 2.6% and 2.8% in HBsAg-negative recipients
under hepatitis B immunoglobulin, lamivudine and their combination, respectively.
Liver grafts from anti-HBc positive donors can be safely used, preferentially in HBsAg-positive
or anti-HBc/anti-HBs positive recipients. HBsAg-negative recipients should receive
prophylaxis with lamivudine, while both anti-HBc and anti-HBs positive recipients
may need no prophylaxis at all.