Background: Limited data exists regarding the rates of reactivation of hepatitis B virus (HBV) in anti-HBc Ab positive orthotopic liver transplant (OLT) recipients. Protocols vary by transplant center and consensus recommendations are based solely on expert opinion. The purpose of this study is to evaluate the incidence of HBV reactivation in anti-HBc Ab positive OLT recipients.

Methods: A single center, retrospective, observational study was conducted in anti-HBc Ab positive, HBsAg negative OLT recipients between May 1, 2011 and October 31, 2017 at an academic medical center. Donor HBsAg or anti-HBc Ab positive grafts were excluded from the analysis.

Results: Nineteen consecutive patients [16 (84.2%) male, 12 (63.1%) Caucasian, median age 62 (range, 47-69) years] were included with a median follow up of 2.2 (range, 1.15-5.93) years. Eighty-four percent of patients had hepatitis C virus related cirrhosis and 73.6% had concomitant hepatocellular carcinoma. Induction immunosuppression consisted of basiliximab with methylprednisolone (MP) in 36.8% of patients, while 63.2% received MP alone. The majority of patients (73.6%) did not receive hepatitis B immunoglobulin (HBIg). Three patients received post-OLT lamivudine for a median of 20.1 (range, 0.9-65.9) months all of which have since been discontinued. In total, 7 (36.8%) patients received either HBIg and/or antiviral therapy while 12 (63.2%) were managed with monitoring alone. Five months after OLT, one patient in the monitoring cohort had evidence of viral reactivation by HBV DNA PCR analysis (viral load = 2092 copies/mL) without detectable HBsAg. This was not associated with abnormal liver function tests. Treatment was not initiated, and viral load was undetectable one week later. The cumulative rate of viremia was 5.3% for this cohort. There were no HBV-related complications including graft loss, retransplantation, or death.

Conclusions: In this small, low risk cohort of anti-HBc positive/HBsAg negative OLT recipients there were no HBV-related complications. Given the isolated case of transient viremia, further study is required to define optimal screening for these patients.

CITATION INFORMATION: Leistman S., Melaragno J., Dokus M., Al-Judaibi B., Babu T. Making Sense of Hepatitis B Reactivation Risk in Anti-HBc Antibody (Ab) Positive Liver Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress