Hepatitis B core antibody positive donors as a safe and effective therapeutic option to increase available organs for lung transplantation

Transplantation. 2005 Aug 15;80(3):320-5. doi: 10.1097/01.tp.0000165858.86067.a2.


Background: The use of hepatitis B core antibody (HBcAb+) and hepatitis C antibody (HCV Ab+) positive donors represents one strategy to increase available donor organs, but this remains controversial because of concern for viral transmission to recipients. We hypothesized that isolated HBcAb+ donors represent minimal risk of viral transmission in vaccinated lung transplant (LTx) recipients.

Methods: A retrospective study was performed of LTx recipients who received HBcAb+ or HCV Ab+ pulmonary allografts. We analyzed liver function studies, viral hepatitis screening tests, quantitative polymerase chain reaction for hepatitis B viral DNA (HBV DNA) and hepatitis C viral RNA (HCV RNA), freedom from bronchiolitis obliterans syndrome, acute rejection, and survival.

Results: Between April 1992 and August 2003, 456 LTx operations were performed. Twenty-nine patients (HB group) received HBcAb+ allograft transplants with a median posttransplant follow-up of 24.5 months. Three critically ill patients (HC group) received HCV Ab+ allografts with a median follow-up of 21.5 months. One-year survival for the HB group is 83% versus 82% for all patients who received non-HB organs (P=0.36). No patient in the HB group developed clinical liver disease because of viral hepatitis, and all patients alive (n=21) at follow-up are, to date, HBV DNA and/or HBcAb negative. All patients in the HC group tested HCV RNA positive; one patient died of liver failure at 22 months.

Conclusions: Risk of viral transmission with HCV Ab+ allografts seems high after LTx. However, the use of HBcAb+ pulmonary allografts in recipients with prior hepatitis B vaccination seems to be a safe and effective strategy to increase organ availability.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Bronchiolitis Obliterans / etiology
  • Bronchiolitis Obliterans / therapy
  • Cadaver
  • DNA / metabolism
  • Female
  • Follow-Up Studies
  • Graft Rejection
  • Hepacivirus / genetics
  • Hepatitis B / immunology*
  • Hepatitis B Antibodies / metabolism*
  • Hepatitis B Core Antigens / immunology
  • Hepatitis B Core Antigens / metabolism*
  • Hepatitis B virus / genetics
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Liver / metabolism
  • Lung Transplantation / methods*
  • Male
  • Middle Aged
  • Polymerase Chain Reaction
  • RNA, Viral / metabolism
  • Retrospective Studies
  • Time Factors
  • Tissue Donors*
  • Tissue and Organ Procurement / methods*


  • Hepatitis B Antibodies
  • Hepatitis B Core Antigens
  • Immunosuppressive Agents
  • RNA, Viral
  • DNA