Antibodies to hepatitis B surface antigen prevent viral reactivation in recipients of liver grafts from anti-HBC positive donors

January 1, 2002

Gut 2002;50:95-99

Antibodies to hepatitis B surface antigen prevent viral reactivation in

recipients of liver grafts from anti-HBC positive donors

A M Roque-Afonso1, C Feray2, D 2, D Simoneau1, B Roche2, J-F Emile3, M

Gigou2, D Shouval2 and E Dussaix1

1 Laboratoire de Virologie, Hôpital Brousse, Université Paris-Sud UPRES

1596, 12 avenue Vaillant Couturier, 94804 Villejuif, France

2 Centre Hépato-Biliaire, Institut National de la Santé et de la Recherche

Médicale, No 9941, Hôpital Brousse, Université Paris-Sud UPRES 1596, 12

avenue Vaillant Couturier, 94804 Villejuif, France

3 Laboratoire d'Anatomo-Pathologie, Hôpital Brousse, Université

Paris-Sud UPRES 1596, 12 avenue Vaillant Couturier, 94804 Villejuif,

France

Correspondence to:

A M Roque-Afonso, Laboratoire de Virologie, Hôpital Brousse, Université

Paris-Sud UPRES 1596, 12 avenue Vaillant Couturier, 94804 Villejuif,

France;

anne-marie.roque@...

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.

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January 1, 2002