Rapid Communication
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World J Gastroenterol. Apr 7, 2006; 12(13): 2070-2074
Published online Apr 7, 2006. doi: 10.3748/wjg.v12.i13.2070
Prevention of de novo HBV infection by the presence of anti-HBs in transplanted patients receiving core antibody-positive livers
Rafael Barcena, Gloria Moraleda, Javier Moreno, M Dolores Martín, Emilio de Vicente, Jesús Nuño, M Luisa Mateos, Santos del Campo
Rafael Barcena, Gloria Moraleda, Javier Moreno, Santos del Campo, Department of Gastroenterology, Hospital Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, Ctra. Colmenar Km 9.1, 28034 Madrid, Spain
M Dolores Martín, Digestive Diseases, Hospital Universitario La Paz, 28034 Madrid, Spain
Emilio de Vicente, Jesús Nuño, Department of Surgery, Hospital Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, 28034 Madrid, Spain
M Luisa Mateos, Department of Microbiology, Hospital Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, 28034 Madrid, Spain
Co-first-authors: Rafael Barcena and Gloria Moraleda
Supported by Fundación Manchega de Investigación y Docencia en Gastroenterología and partially by Red Nacional en Investigación de Hepatología y Gastroenterología (RNIHG), Dr. Moraleda was supported by a grant from the Ministerio de Educación y Ciencia (Programa Ramón y Cajal)
Correspondence to: Dr. Rafael Bárcena, MD, Hospital Ramón y Cajal, Department of Gastroenterology, Ctra. Colmenar Km 9.1, 28034 Madrid, Spain. rbarcena.hrc@salud.madrid.org
Telephone: +34-91-3368093 Fax: +34-91-7291456
Received: August 26, 2005
Revised: September 25, 2005
Accepted: October 10, 2005
Published online: April 7, 2006
Abstract

AIM: To analyze whether the presence of anti-HBs in liver transplant recipients is effective in preventing HBV infection.

METHODS: Twenty-three patients receiving anti-HBc positive liver were studied. Nine recipients were anti-HBc positive as a result of previous HBV infection. Of them, one also received HBV vaccine during the pre-liver transplantation period. Fourteen recipients were anti-HBs positive due to HBV vaccine administered during the pre-transplant period. Liver biopsy was obtained in 10/14 anti-HBc negative/anti-HBs positive recipients and in 4/9 anti-HBc positive recipients.

RESULTS: After a mean follow-up period of 46 months, 1 recipient with protective serum anti-HBs levels developed de novo HBV infection as a consequence of immune escape HBV mutants. Among the 14 vaccinated anti-HBc negative/anti-HBs positive recipients, 1/10 patients with available liver biopsy (10%) had liver HBV-DNA at 13 mo post-liver transplantation without serum viral markers and did not develop de novo HBV infection. The vaccinated anti-HBc positive recipient without HBV vaccine response was HBV-DNA positive in serum and liver, viral DNA was continuously negative in the following tests, so a spontaneous seroconversion was diagnosed.

CONCLUSION: The presence of anti-HBs as a result of HBV vaccine or past HBV infection seems to be effective at protecting patients receiving livers from anti-HBc positive donors. However, the emergence of immune escape HBV mutants, which can evade the anti-HBs protection, should be considered as a risk of HBV infection.

Keywords: HBV vaccine; Liver transplantation; De novo HBV infection; Hepatitis B core antibody