Risk of transmission of hepatitis B virus from anti-HBc positive cadaveric organ donors: A collaborative study

Organ donors with a serologic profile of recovered (HBsAg negative and/or anti-HBc IgG positive) hepatitis B virus infection (HBV) have been reported to transmit HBV to recipients. In Italy, up until 2002, anti-HBc determination was not mandatory. We retrospectively evaluated the incidence of HBV transmission among recipients transplanted with organs from anti-HBc positive donors from 1997 to 1999. Anti-HBc was screened in 886 available sera among 964 HBsAg and anti-HCV negative donors. HBV transmission was evaluated in 325 kidney, liver, and heart recipients according to their pretransplant HBV serum profile. Of 210 anti-HBc positive donors, 185 were anti-HBc positive/anti-HBs positive and 25 anti-HBc positive/anti-HBs negative with a prevalence of 20.8% and 2.8%, respectively. One hundred seven sera (51%) were collected from donors after transfusion of blood components, the remainder were either before transfusion or from nontransfused donors. The 210 anti-HBc positive subjects donated 356 kidneys, 117 livers and 117 hearts, among whom follow-up is presently available for 251 kidney, 61 liver, and 25 heart recipients. No HBV transmission was observed independent of the recipient immunological profile among the kidney or heart recipients. In liver recipients, no transmission was reported in recovered or vaccinated patients, while a high incidence (43%) of de novo hepatitis was observed among naive patients. In conclusion, there does not seem to be a risk of transmitting HBV through anti-HBc positive transplants in heart and kidney recipients; only naive liver recipients are at high risk of HBV infection.