Safety and outcome of hepatitis B core antibody-positive donors in right-lobe living donor liver transplantation

Are we ready for marginal hepatitis B core antibody-positive living liver donors?

“…1,2 The study by Lo et al 21 suggests that HBV reactivation in carefully selected HBcAb ϩ Asian donors is unlikely, and adequate regeneration presumably can be achieved in the majority of donors without steatosis.…”

Outcomes of liver transplantation using Hepatitis B core-positive liver grafts: Implications for prophylaxis

“…Hepatic HBV DNA was found in 50% to 73% of healthy anti-HBc-positive living donors, yet serum HBV DNA was negative in all donors [36]. A report of 54 right lobe living anti-HBc-positive donors demonstrated de novo infection in 54% of recipients without any increase in surgical complications or length of hospital stay [37]. These results support the safety of right lobe hepatectomy in otherwise healthy anti-HBc-positive donors.…”

“…Lamivudine is attractive because it is inexpensive and safe, but a major concern with longterm administration is the emergence of drug-resistance mutant strains. Viral breakthrough with the tyrosine, methionine, and aspartic acid (YMDD) mutant has been reported to occur in 3.8% to 32% of cases during lamivudine monotherapy after liver transplantation [37,44]. When mutations develop, other antiviral therapy should be initiated.…”

Donor Safety in Live-Related Liver Transplantation

“…Donors with hepatitis B core antibody (HBcAb) are suitable for donation, but the potential donors need testing for HBV DNA. Recipients of grafts from such donors may require lifelong lamivudine treatment [20]. However, there are suggestions that recipients with hepatitis B surface antibody positivity and donors with hepatitis B DNA negativity may have their lamivudine terminated after transplant [21].…”