Liver transplantation in hepatitis B core-negative recipients using livers from hepatitis B core-positive donors: a 13-year experience

Liver Transpl. 2013 Jun;19(6):611-8. doi: 10.1002/lt.23644.


The use of livers from hepatitis B surface antigen-negative (HBsAg- )/hepatitis B core antibody-positive (HBcAb+ ) donors in liver transplantation (LT) for HBsAg(-) /HBcAb- recipients is still controversial because of a lack of standard antiviral prophylaxis and long-term follow-up. We present our 13-year experience with the use of HBcAb+ donor livers in HBcAb- recipients. Patients received prophylaxis with hepatitis B immunoglobulin at the time of LT and then lamivudine daily. De novo hepatitis B virus (HBV) was defined as positive HBV DNA detection. Between January 1999 and December 2010, 1013 adult LT procedures were performed at our center. Sixty-four HBsAg- /HBcAb- patients (6.3%) received an HBsAg- /HBcAb+ liver. All donor sera were negative for HBcAb immunoglobulin M and HBV DNA. The mean follow-up was 48.8 ± 40.1 months (range = 1.2-148.8). Both the patient survival rates and the graft survival rates were 92.2% and 69.2% at 1 and 5 years, respectively. No graft losses or deaths were related to de novo HBV. Nine of the 64 patients (14.1%) developed de novo HBV. The mean time from LT to de novo HBV was 21.4 ± 26.1 months (range = 10.8-92.8 months). De novo HBV was successfully treated with adefovir or tenofovir. In conclusion, HBcAb+ allografts can be safely used in HBcAb- recipients without increased mortality or graft loss. Lifelong prophylaxis, continuous surveillance, and compliance are imperative for success. Should a de novo infection occur, our experience suggests that a variety of treatments can be employed to salvage the graft and obtain serum HBV DNA clearance.

MeSH terms

  • Adult
  • Aged
  • DNA, Viral / isolation & purification
  • Female
  • Follow-Up Studies
  • Graft Survival
  • Hepatitis B / pathology
  • Hepatitis B / transmission*
  • Hepatitis B Core Antigens / metabolism
  • Hepatitis B Surface Antigens / metabolism
  • Humans
  • Immunoglobulins / therapeutic use
  • Immunosuppressive Agents / therapeutic use
  • Lamivudine / therapeutic use
  • Liver / virology
  • Liver Failure / complications
  • Liver Failure / therapy*
  • Liver Transplantation / methods*
  • Male
  • Middle Aged
  • Time Factors
  • Tissue Donors*
  • Treatment Outcome


  • DNA, Viral
  • Hepatitis B Core Antigens
  • Hepatitis B Surface Antigens
  • Immunoglobulins
  • Immunosuppressive Agents
  • Lamivudine
  • hepatitis B hyperimmune globulin