Korean J Transplant.  2022 Nov;36(Supple 1):S246. 10.4285/ATW2022.F-3853.

De novo hepatitis B virus infection after liver transplantation from anti-hepatitis B core antibody positive donor: a 20-year experience at a single center

• Visutjindapon O
• Kositamongkol P
• Tovikkai C
• Sirivatanauksorn Y
• Limsrichamrern S
• Mahawithitwong P
• Dumronggittigule W
• Sangserestid P
• Assawasirisin C

• KMID: 2535463
• DOI: http://doi.org/10.4285/ATW2022.F-3853

Abstract

Background
As an endemic area of hepatitis B virus (HBV), Thailand has a significant proportion of liver donors who were previously infected with HBV. Liver transplantation (LT) from anti-hepatitis B core antibody (anti-HBc) positive donor to hepatitis B surface antigen (HBsAg) negative recipient has some risk for de novo HBV infection. The aim of this study is to evaluate the in-cidence and factors associated with de novo HBV infection after LT from anti-HBc positive donors in non-hepatitis B recipients.
Methods
We retrospectively reviewed 396 patients who underwent LT between 2002 to 2021 at Siriraj Hospital, Bangkok, Thailand. Among these, there were 75 HBsAg negative recipients receiving anti-HBc positive liver grafts. De novo HBV infection was defined as HBsAg positive detected after LT. Incidence of de novo HBV infection was calculated and associated factors, such as pre- and posttransplant hepatitis B immunoglobulin (HBIG) and antiviral, were evaluated.
Results
De novo HBV infection occurred in 12 recipients (16%). The median time to de novo HBV infection was 1,133 days. Posttransplant antiviral drug (lamivudine) was the significant protective factor against de novo HBV infection (P<0.001). There was no de novo HBV infection occurred in recipients who continuously received posttransplant lamivudine. While 36.8% of recipients who did not receive and 27.8% of recipients who discontinued lamivudine during the posttransplant period had de novo HBV infection. Recipients who received pretransplant and posttransplant HBIG had a trend to have a lower rate of de novo HBV infection (9.8% vs. 29.2%, P=0.05 and 8.7% vs. 27.6%, P=0.05, respectively). Pretransplant anti-HBs and anti-HBc antibody sta-tus, pretransplant antiviral, and posttransplant HBV vaccine were not significant factors related to de novo HBV infection.
Conclusions
Anti-HBc positive liver grafts are safe to be transplanted to HBsAg negative recipients if they receive suitable pro-phylaxis especially posttransplant antiviral medication continuously.