Results of Use of Hepatitis B Core Antibody-Positive Donors in Living Donor Liver Transplantation with Passive Immunoprophylaxis

Choi, Dong Lak; Lee, Sung Gyu; Lee, Young Joo; Park, Kwang Min; Hwang, Shin; Kim, Ki Hun; Nam, Choong Hyeon; Ahn, Chul Soo; Jeong, Jae Han; Min, Pyung Chul

Abstract

BACKGROUND: In Korea, the number of patients enrolled in liver transplantation registry exceeds the supply of cadaveric donor. This donor shortage leads to living donor liver transplantation(LDLT). Due to wide prevalence of hepatitis B in Korea, many healthy donors for LDLT shows hepatitis B surface antigen-negative[HBsAg(-)] and core antibody-positive [HBcAb(+)]. However, the risk of using graft livers from HBsAg(-) and HBcAb(+) donors has not been clearly defined. The aim of this study is to identify the safety of using HBcAb(+) donor and the effectiveness of passive immunoprophylaxis with hepatitis B immunoglobulin(HBIG) in non-hepatitis B virus induced cirrhotic recipients.
METHODS
From December 1994 to July 1998, 59 patients underwent living donor liver transplantation at the Asan Medical Center. Among them, 35 cases were non-hepatitis B virus induced cirrhotic recipients. Of these 35 recipients, 14 patients received liver graft from HBsAg(-) and HBcAb(+) donors and prophylactic passive immunoprophylaxis with HBIG.
RESULTS
Eleven cases remained HBsAg(-) with HBIG immunoprophylaxis. Three of 14 recipients who were HBsAg(-) converted to HBsAg(+) serologically after receiving HBcAb(+) donor liver. All of these 3 cases did not receive HBIG therapy.
CONCLUSIONS
Passive immunoprophylaxis with HBIG may prevent non-hepatitis B induced cirrhotic recipients from converting to HBsAg(+) status by using HBcAb(+) donor. Our experience suggests that HBcAb(+) donors can be accepted as potential donors in living donor liver transplantation.