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

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(-), antiHBc(-)). The single patient who received HBIG mono therapy 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.