Background) Controversy still exists concerning the use of livers from hepatitis B surface antigen-negative (HBsAg-)/hepatitis B core antibody-positive (HBcAb+) donors for liver transplantation (LT). We describe our experience of LT using HBcAb+ livers in pediatric recipients.

Methods) From June 1996 to October 2013, 197 cases of pediatric LT were performed in Samsung Medical Center (Seoul, Korea). Fifty-two liver grafts (52/197, 26.4%) were from HBcAb+ donors. De novo hepatitis B prophylaxis for recipients of HBcAb+ livers was given as hepatitis B immunoglobulin (HBIG) 100 IU/kg given intravenously during the anhepatic phase and once daily for 6 days postoperatively. Then, HBIG was given intermittently to maintain HBsAb titers above 200 IU/L for one year postoperatively. Then, hepatitis B vaccine (Hepavax) was given intermittently to maintain HBsAb titers above 100 IU/L.

Results) Twenty-one cases were male and 31 cases were female recipients. Mean age was 6.6 years (range 4 months ∼ 16 years). Forty-seven cases were living donor LT and 5 cases were deceased donor LT. Median follow-up period was 71 months following LT (range 1∼202 months). Recipient hepatitis B serologic status were as follows: HBcAb+/HBsAb+ 5 cases, HBcAb-/HBsAb+ 26 cases, HBcAb-/HBsAb- 15 cases. There were 3 cases (3/52, 5.8%) of de novo hepatitis B encountered during the follow-up period. De novo hepatitis was detected at 6, 16 and 20 months post-LT, respectively. All patients were initially managed with lamivudine. Two patients developed lamivudine resistance and were switched to entecavir. Negative seroconversion was achieved in two patients, one with lamivudine alone and the other with entecavir. All patients are alive with stable functioning grafts 42, 182 and 183 months after occurrence of de novo hepatitis B. Ten-year protocol liver biopsies were done in two patients, including one patient with persistent HBsAg positivity. Biopsy results showed no signs of viral hepatitis or fibrosis in either patients.

Conclusion) LT using HBcAb+ livers resulted in 5.8% incidence of de novo hepatitis B in our pediatric recipients. However, de novo hepatitis B did not compromise graft function or patient survival.

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