Transmission of hepatitis B virus from hepatitis B core antibody-positive donors in living related liver transplants

Transplantation. 1998 Feb 27;65(4):494-9. doi: 10.1097/00007890-199802270-00007.


Background: In order to clarify the risk of hepatitis B virus (HBV) transmission from hepatitis B core antibody-positive (HBcAb(+)) donors and to evolve a new strategy to counter such a risk, we undertook a retrospective (1990-1995) and prospective (1995-1996) analysis of our experience with living related liver transplantation involving HBcAb(+) donors.

Methods: Between June 15, 1990, and June 30, 1995, HBcAb(+) individuals were not excluded as donor candidates at our institutions. For 171 liver transplants, 16 donors were HBcAb(+). Between July 1, 1995, and June 30, 1996, HBcAb(+) individuals were generally excluded as donor candidates; however, three recipients were given liver grafts from HBcAb(+) donors because other donor candidates presented even higher risks. In the latter period, recipients with transplants from HBcAb(+) donors underwent prophylactic passive immunization with hyperimmune hepatitis B immunoglobulin (HBIG). The serum of 10 HBcAb(+) donors was examined by nested polymerase chain reaction for the presence of HBV-DNA, but it was not detected in any of them. However, the same examination of the liver tissue of five such donors yielded positive results in all cases.

Results: In the first 5-year period, out of 16 recipients with HBcAb(+) donors, 15 became hepatitis B surface antigen-positive after transplant. The three recipients with HBcAb(+) donors during the second 1-year period, who were treated by prophylactic passive immunization with HBIG, remained hepatitis B surface antigen-negative and negative for serum HBV-DNA after transplant.

Conclusions: HBV exists in the liver of healthy HBcAb(+) individuals, but not in the blood. Therefore, HBV is thought to be transmitted to recipients by liver grafts from the HBcAb(+) donors at a significantly high rate. The prevention of viral activation and clinical disease development by means of passive immunization with HBIG seems promising, although the follow-up period in our study may be too short for any definitive conclusions.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • DNA, Viral / analysis
  • DNA, Viral / blood
  • Family
  • Hepatitis B / transmission*
  • Hepatitis B Antibodies / blood*
  • Hepatitis B Antigens / blood*
  • Hepatitis B Core Antigens / blood*
  • Hepatitis B virus / isolation & purification*
  • Humans
  • Liver Transplantation*
  • Living Donors*
  • Polymerase Chain Reaction


  • DNA, Viral
  • Hepatitis B Antibodies
  • Hepatitis B Antigens
  • Hepatitis B Core Antigens