The use of virologically compromised organs in liver transplantation

Liver transplant from Anti-HBc-positive, HBsAg-negative donor into HBsAg-negative recipient: is it safe? A systematic review of the literature

INTRODUCTION

After liver transplant (LT) from Anti-HBc+/HBsAg- donors into HBsAg- recipients, transmission of hepatitis B virus (HBV) may occur (de novo HBV infection). This study analyzes the incidence of de novo HBV infection in HBsAg- recipients of Anti-HBc+/HBsAg- LT with respect to: (i) the recipients' HBV serology and (ii) the type of preventive therapy adopted.

METHODS

A systematic review of the literature using the electronic database Medline.

RESULTS

Five hundred and fifty-two LT in 36 articles were selected. Lamivudine, Hepatitis B immune globulin (HBIG), revaccination, and combined therapies were employed in multiple strategies as preventive interventions. Naïve recipients had a high risk of de novo HBV infection, with smaller incidences when HBIG and lamivudine were used, either alone or in association. Vaccinated recipients or those with isolated hepatitis B core antibodies (Anti-HBc) and previous HBV infection had lower risks of viral transmission, additionally reduced by any prophylaxis adoption.

DISCUSSION

LT from Anti-HBc+/HBsAg- donors into HBsAg- recipients is apparently safe, as long as the recipient is vaccinated or presents an isolated Anti-HBc or previous HBV infection and some prophylaxis is employed. Currently lamivudine seems the best alternative; other nucleoside analogs and revaccination strategies should be considered in future studies. Follow-up and preventive therapies should be maintained for five yr or preferably throughout the recipients' life span.

Expanding donor options: marginal, living, and split donors

One of the most important factors in the increasing number of liver transplantations performed in the United States is the growing acceptance of marginal grafts, which are defined as organs at increased risk for poor function or failure that may subject the recipient to greater risks of morbidity or mortality. Based on encouraging results, a growing number of liver transplantation centers are broadening their criteria for transplantation of marginal grafts. This article discusses the use of the extended criteria donor liver, split-liver, and living-donor liver transplantation.