Does lamivudine prophylaxis eradicate persistent HBV DNA from allografts derived from anti-HBc-positive donors?

Current use of hepatitis B immune globulin for prevention of de novo hepatitis B in recipients receiving anti-HBc-positive livers

“…With HBIG monotherapy prophylaxis, DNH occurred from 11.1 to 100% in naïve recipients (Table 3) [18,20,21,24,27,29,33,34,36,38,39,41,44]. Overall, HBIG monotherapy decreases DNH occurrence rate from 65.2 to 28% in this high-risk population.…”

“…Nevertheless, monotherapy appears not as good as combination therapy since there was no DNH in 43 naïve recipients treated with combination therapy (Tables 1, 3). HBIG monotherapy effectively prevents the occurrence of DNH in 22 and 12 recipients who were positive for either anti-HBs or anti-HBc alone, respectively (Table 3) [20,24,26,27,29,33,34,36,39,40,42,44]. This population has intermediate risk (20%) of developing DNH when receiving a liver from anti-HBcpositive donors (Table 1).…”

“…This finding suggests that IM HBIG may not be the best immediate postoperative prophylaxis especially for patients who have a high viral load before LT and hence require higher protective antibody level after LT. Nonetheless, low-dose IM or SC HBIG may be a good alternative for prevention of DNH since recipients receiving isolated anti-HBc-positive livers should not have detectable viremia immediately after LT. One patient dropped from the prophylaxis protocol due to poor compliance [33] } Five of six patients developed surface escape mutation [27] ¥ The patient developed surface escape mutation [27] § One patient dropped from the prophylaxis protocol due to poor compliance [33] £ One patient developed lamivudine-resistant polymerase mutant [42] and the other stopped prophylactic lamivudine 2 months prior to developing DNH [44] HBV hepatitis B, anti-HBs antibody against hepatitis B surface antigen, anti-HBc antibody against hepatitis B core antigen, DNH de novo hepatitis B * Single patient did not compliant with lamivudine prophylaxis [29] One patient was seroconverted for anti-HBc but remained negative for HBV DNA and hepatitis B surface antigen [31] } Single patient did not compliant with lamivudine prophylaxis [29] Hepatol Int (2011) 5:635-643 639…”

Virologically compromised donor grafts in liver transplantation

“…Several studies have confirmed the presence of HBV DNA in the liver in up to 57% of anti-HBcC donors [3,5,29]. Only a few such patients have detectable serum HBV DNA, and for this reason absence of this marker does not preclude transmission of HBV to recipients.…”

Controversies Regarding the Hepatitis B Immune Globulin Prophylaxis (HBIG) for Liver Transplantation Recipients

“…Angus/2008 [32] Avolio/2008 [106] Angus/2000 [51] Anselmo/2002 [33] Anderson/2007 [107] Alonso/2003 [108] Brock/2011 [109] Buti/2003 [110] Ben-Ari/2004 [111] Chun/2010 [112] Dadson/2000 [113] Dehghani/2013 [114] Dickson/2006 [59] Dumortier/2003 [115] Degertekin/2010 [116] Di Paolo/2004 [117] Faust/2003 [118] Freshwater/2008 [99] Fabrega/2003 [119] Feretti/2004 [120] Filipponi/2010 [121] Gane/2013 [55] Han/2000 [35] Han/2003 [122] Honaker/2002 [123] Iacob/2008 [124] Jiang/2010 [125] Jain/2005 [126] Jiao/2007 [127] Karademir/2006 [128] Kwon/2006 [129] Lee/2000 [130] Lee/2004 [131] Lu/2004 [85] Lu/2008 [39] Loss/2003 [132]…”