Prevention of de novo Hepatitis B Infection from HBcAb Positive Donors in Living Donor Liver Transplantation

Lee, Kwang Woong; Lee, Dae Sung; Joh, Jae Won; Kim, Sung Ju; Choi, Sung Ho; Heo, Jin Seok; Choi, Yeon Ho; Lee, Suk Koo

Abstract

PURPOSE
HBV prophylaxis is necessary to prevent de novo hepatitis B infection from HBcAb positive donors. However, it is somewhat controversial in which protocol is more effective, and whether it is necessary to administer the HBV prophylaxis for HBsAb positive recipients. In this study, we attempted to elucidate whether it is necessary to administer the HBV prophylaxis for HBsAb positive patients and to evaluate the efficacy of HBIG monotherapy protocol.
METHODS
From May 1996 to July 2001, 58 donors (45.3%) were HBcAb positive among 128 donors who were examined for HBcAb. Eighteen HBcAb positive grafts were transplanted to HBsAg negative recipients. Four patients died of unrelated causes were excluded. Of 14 study cases, 12 recipients were HbsAb positive, and 2 were negative. Among 12 HBsAb positive recipients, 3 were HbcAb positive simultaneously. In early period (Nov. 1997~Nov. 1998), only HBV vaccination was applied for de novo infection prophylaxis. In late period (since Dec. 1998), regardless of HBsAb positivity in recipients, HBIG was administered from the beginning of liver transplantation.
RESULTS
The overall de novo HBV infection from HBcAb positive donors was 21.4 % (3/14). All 3 recipients without HBIG prophylaxis presented de novo HBV infection. Two of them were HBsAb positive postoperatively. No de novo HBV infection occurred in recipients with HBIG prophylaxis.
CONCLUSION
It is necessary to administer the HBV prophylaxis even for vaccinated HBsAb positive patients and HBIG monotherapy protocol is effective to prevent de novo hepatitis B infection from HBcAb positive donors in living donor liver transplantation.