Positive suggestions about the anti-HBc positive donor

Abstract

What to do with the anti-hepatitis B virus core antigen positive donor liver The paper by Roque-Afonso et al in this issue of Gut 1 describes the outcome of recipients following transplantation of livers from organ donors who have detectable antibody to the hepatitis B virus (HBV) core antigen (HBc) but undetectable serum hepatitis B surface antigen (anti-HBc positive, HBsAg negative) (see 95). Serum anti-HBc positivity simply confirms exposure to HBV. Its presence in the absence of serum HBsAg identifies the patient with resolved infection. Frequently, antibodies to HBsAg (anti-HBs) will be absent, fading in titre for many patients from the time of acute infection. Thus the patient with a past resolved HBV infection will be anti-HBc positive and HBsAg negative, and anti-HBs may or may not be present. Irrespective of the anti-HBs status of the donor, it is known that the use of anti-HBc positive (HBsAg negative) donor livers will transmit HBV to the recipient and will establish chronic infection and graft damage.2–5 This is termed de novo HBV infection. Occasionally, aggressive infection with graft failure and patient death may be observed.6 In general, the other organs of the anti-HBc positive donor can be used with little risk of de novo infection to the …