Prevention of de novo hepatitis B infection in recipients of hepatic allografts from anti-HBc positive donors

Transplantation. 1999 Oct 15;68(7):1058-61. doi: 10.1097/00007890-199910150-00028.


Background: The shortage of donor organs occasionally mandates the use of hepatic allografts from anti-HBc+ donors in recipients who are susceptible to de novo hepatitis B virus (HBV) infection. The efficacy of hepatitis B immune globulin and lamivudine to prevent de novo HBV infection in anti-HBs negative recipients of allografts from anti-HBc+ donors has not been investigated.

Methods: After liver transplantation with an allograft from a donor positive for anti-HBc, recipients who were anti-HBs-, HbsAg- received hepatitis B immune globulin (HBIG) 10,000 IU i.v. daily for 7 days and monthly for 6 months. After 6 months, 1000 IU of HBIG was given IM. every 2 weeks for 18 months. Patients transplanted after 4/1/97 were given lamivudine 150 mg daily starting postoperative day 1.

Results: Between 8/14/96 and 6/10/98, 264 orthotopic liver transplants were performed and 16 anti-HBs-, HbsAg- patients received an hepatic allograft from a donor positive for anti-HBc. HBIG mono-therapy was administered to one patient. HBIG and lamivudine combination therapy was administered to 15 patients. Of the 16 patients, 8 were positive only for anti-HBc before transplant, and 8 were naive (anti-HBs-, anti-HBc-). The single patient who received HBIG monotherapy became HbsAg+ at 6 months. All patients receiving combination therapy with HBIG and lamivudine have remained HbsAg-. The average follow-up is 459 days (range 170-754). Two patients died from unrelated causes.

Conclusions: Combination therapy with HBIG and lamivudine may prevent de novo HBV infection in anti-HBs-, HbsAg- recipients of hepatic allografts from anti-HBc+ donors.

MeSH terms

  • Hepatitis B / blood
  • Hepatitis B / prevention & control*
  • Hepatitis B Antibodies / blood*
  • Hepatitis B Core Antigens / immunology*
  • Hepatitis B virus / immunology*
  • Humans
  • Immunization, Passive
  • Immunoglobulins
  • Lamivudine / therapeutic use
  • Liver Transplantation / adverse effects*
  • Prospective Studies
  • Reverse Transcriptase Inhibitors / therapeutic use
  • Tissue Donors
  • Transplantation, Homologous


  • Hepatitis B Antibodies
  • Hepatitis B Core Antigens
  • Immunoglobulins
  • Reverse Transcriptase Inhibitors
  • Lamivudine
  • hepatitis B hyperimmune globulin