Background: Living donor liver transplantation (LDLT) is lifesaving for patients with end-stage liver disease, especially where cadaveric grafts are limited. Some centers may exclude potential donors with positive auto-antibodies (AAbs) due to concerns of autoimmune hepatitis (AIH) and jeopardizing donor safety. This scoping review evaluates the natural history and clinical significance of AAbs in LDLT donors. Methods: A comprehensive search of PubMed, Embase, and Cochrane Library was conducted, following PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines and under consultation with an experienced librarian. English articles published from 2000 to 2024 were included. Two reviewers independently assessed eligibility and extracted relevant data on study characteristics, AAb types, donor demographics, follow-up duration, and clinical outcomes. Results: Of 1,067 screened studies, 22 were relevant (20 focused on donor outcomes and protocols, 2 on AAb screening in donor selection). Only one study specifically mentioned that a normal autoimmune workup is necessary for donor eligibility. Regarding the natural history of AAbs, 10 studies were relevant, including 2 reviews on prognosis. No conclusive evidence linked AAbs to increased AIH risk in donors with normal liver function. Conclusion Significant knowledge gaps exist regarding AAbs in donor safety and their natural history. Donor screening practices varied widely across institutions.AAbs are neither routinely screened nor considered an exclusion criterion in most centres. In asymptomatic individuals with normal liver function and AAbs, there does not appear to be an elevated risk for developing AIH. This review maps existing gaps in literature and highlights areas for future research.

Humans ; Carcinoma, Hepatocellular/epidemiology* ; Liver Neoplasms/epidemiology* ; Prothrombin ; Biomarkers

Cost of Illness ; Financial Stress ; Hepatitis B, Chronic ; Humans ; Perception ; Self Report

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.