Understanding the hepatitis B core positive liver donor.

Author: Kah Wai Clarence KWAN ¹ ; Teegan Reina LIM ¹ ; Rajneesh KUMAR ¹ ; Thinesh Lee KRISHNAMOORTHY ¹
Author Information

1. Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
Publication Type:Journal Article
Keywords: core positive donor; liver transplant; occult hepatitis B; viral reactivation
From:Singapore medical journal 2019;60(10):545-549
CountrySingapore
Language:English
Abstract: The increasing number of patients on the Singapore national liver transplant waiting list and the lack of donor livers have necessitated a review of the limited use of marginal donor liver grafts. Some grafts are of good quality but are considered marginal due to positive donor antibody to hepatitis B virus core protein serology, and negative hepatitis B surface antigen (HBsAg) and hepatitis B DNA. The fear is of viral reactivation during periods of intense immunosuppression. This is made possible by the ability of the hepatitis B virion to reside in a dormant state within the hepatocyte nucleus despite HBsAg clearance, i.e. the occult hepatitis B infection (OBI). In truth, appropriate selection of recipients and effective post-transplantation immunoprophylaxis significantly reduce the risk of hepatitis B viral reactivation. This article explains the confusion surrounding OBI and reviews current recommendations on how to manage such donor liver grafts.