Session Type: 1-hour Oral Session
Session Title: 1-hour Oral Session
Authors(s): A. Gupta (1), N. Kumbhar (1), R. Agarwal (1), A. Choudhury (2), V. Pamecha (3), E. Gupta (1)
Authors Affiliations(s): (1) Department of Clinical Virology, Institute of Liver and Biliary Sciences, India, (2) Department of Hepatology, Institute of Liver and Biliary Sciences, India, (3) Department of Hepatobiliary Surgery and Liver Transplant, Institute of Liver and Biliary Sciences, India
Background:
Organ shortages in liver transplantation (LT) have led to an increase in the use of donors with hepatitis B (HBV) positive serology. However, the risk of acquiring new HBV infection in HBV naïve LT recipients from anti-HBc positive donors is substantial (38%-100%). Risks are found to be lower for recipients with anti-HBs titer >10 mIU/mL and highest in those with anti-HBs <10 mIU/mL or negative anti-HBc total.
Methods:In this retrospective study, from January 2015 to September 2019, recipients of anti-HBc positive liver grafts were followed up for the occurrence of HBV infection post LT.
Results:A total of 34 patients with a mean age of 40.8±14.4 years received anti-HBc positive liver grafts. All patients were male and the majority presented with chronic liver disease related to HBV (13, 38.2%) or alcoholic liver disease (13, 38.2%). All patients received tenofovir or entecavir prophylaxis for HBV and were followed up for a median of 10 months (range 2-34 months) post-transplant. Prior to LT, anti-HBc positive recipients were 19 (55.8%) and negative were 15 (44.1%). Post LT, HBV recurrence was not found in the anti-HBc positive recipient group. However, 2/15 (13.3%) cases of HBV occurrence were found among the anti-HBc negative recipients. On further analysis, these recipients were found to have pre LT anti-HBs titers of <10 mIU/mL. Interestingly, their donors had pre-LT anti-HBs titers of >100 mIU/mL, suggesting adequate protective antibodies. Both HBV naïve recipients were diagnosed with new HBV infection after 22 and 32 months post LT, despite adequate antiviral treatment. Serological markers (HBsAg, HBeAg) were found to be positive along with HBV viral load of 2.04x103 IU/ml and 6.80x107 IU/ml respectively in these cases.
Conclusions:Anti-HBc positive grafts can be safely given in recipients with protective anti-HBs titers. Cases of new HBV infection post anti-HBc positive graft transplants require careful virological surveillance along with an evaluation of immunological response. Post-transplant vaccination for HBV naïve recipients of anti-HBc positive liver grafts could be incorporated into the current guidelines.
Keyword(s): HBsAg, transplant immunology, HBV DNASession Type: 1-hour Oral Session
Session Title: 1-hour Oral Session
Authors(s): A. Gupta (1), N. Kumbhar (1), R. Agarwal (1), A. Choudhury (2), V. Pamecha (3), E. Gupta (1)
Authors Affiliations(s): (1) Department of Clinical Virology, Institute of Liver and Biliary Sciences, India, (2) Department of Hepatology, Institute of Liver and Biliary Sciences, India, (3) Department of Hepatobiliary Surgery and Liver Transplant, Institute of Liver and Biliary Sciences, India
Background:
Organ shortages in liver transplantation (LT) have led to an increase in the use of donors with hepatitis B (HBV) positive serology. However, the risk of acquiring new HBV infection in HBV naïve LT recipients from anti-HBc positive donors is substantial (38%-100%). Risks are found to be lower for recipients with anti-HBs titer >10 mIU/mL and highest in those with anti-HBs <10 mIU/mL or negative anti-HBc total.
Methods:In this retrospective study, from January 2015 to September 2019, recipients of anti-HBc positive liver grafts were followed up for the occurrence of HBV infection post LT.
Results:A total of 34 patients with a mean age of 40.8±14.4 years received anti-HBc positive liver grafts. All patients were male and the majority presented with chronic liver disease related to HBV (13, 38.2%) or alcoholic liver disease (13, 38.2%). All patients received tenofovir or entecavir prophylaxis for HBV and were followed up for a median of 10 months (range 2-34 months) post-transplant. Prior to LT, anti-HBc positive recipients were 19 (55.8%) and negative were 15 (44.1%). Post LT, HBV recurrence was not found in the anti-HBc positive recipient group. However, 2/15 (13.3%) cases of HBV occurrence were found among the anti-HBc negative recipients. On further analysis, these recipients were found to have pre LT anti-HBs titers of <10 mIU/mL. Interestingly, their donors had pre-LT anti-HBs titers of >100 mIU/mL, suggesting adequate protective antibodies. Both HBV naïve recipients were diagnosed with new HBV infection after 22 and 32 months post LT, despite adequate antiviral treatment. Serological markers (HBsAg, HBeAg) were found to be positive along with HBV viral load of 2.04x103 IU/ml and 6.80x107 IU/ml respectively in these cases.
Conclusions:Anti-HBc positive grafts can be safely given in recipients with protective anti-HBs titers. Cases of new HBV infection post anti-HBc positive graft transplants require careful virological surveillance along with an evaluation of immunological response. Post-transplant vaccination for HBV naïve recipients of anti-HBc positive liver grafts could be incorporated into the current guidelines.
Keyword(s): HBsAg, transplant immunology, HBV DNA
Session Type: 1-hour Oral Session
Session Title: 1-hour Oral Session
Authors(s): A. Gupta (1), N. Kumbhar (1), R. Agarwal (1), A. Choudhury (2), V. Pamecha (3), E. Gupta (1)
Authors Affiliations(s): (1) Department of Clinical Virology, Institute of Liver and Biliary Sciences, India, (2) Department of Hepatology, Institute of Liver and Biliary Sciences, India, (3) Department of Hepatobiliary Surgery and Liver Transplant, Institute of Liver and Biliary Sciences, India
Background:
Organ shortages in liver transplantation (LT) have led to an increase in the use of donors with hepatitis B (HBV) positive serology. However, the risk of acquiring new HBV infection in HBV naïve LT recipients from anti-HBc positive donors is substantial (38%-100%). Risks are found to be lower for recipients with anti-HBs titer >10 mIU/mL and highest in those with anti-HBs <10 mIU/mL or negative anti-HBc total.
Methods:In this retrospective study, from January 2015 to September 2019, recipients of anti-HBc positive liver grafts were followed up for the occurrence of HBV infection post LT.
Results:A total of 34 patients with a mean age of 40.8±14.4 years received anti-HBc positive liver grafts. All patients were male and the majority presented with chronic liver disease related to HBV (13, 38.2%) or alcoholic liver disease (13, 38.2%). All patients received tenofovir or entecavir prophylaxis for HBV and were followed up for a median of 10 months (range 2-34 months) post-transplant. Prior to LT, anti-HBc positive recipients were 19 (55.8%) and negative were 15 (44.1%). Post LT, HBV recurrence was not found in the anti-HBc positive recipient group. However, 2/15 (13.3%) cases of HBV occurrence were found among the anti-HBc negative recipients. On further analysis, these recipients were found to have pre LT anti-HBs titers of <10 mIU/mL. Interestingly, their donors had pre-LT anti-HBs titers of >100 mIU/mL, suggesting adequate protective antibodies. Both HBV naïve recipients were diagnosed with new HBV infection after 22 and 32 months post LT, despite adequate antiviral treatment. Serological markers (HBsAg, HBeAg) were found to be positive along with HBV viral load of 2.04x103 IU/ml and 6.80x107 IU/ml respectively in these cases.
Conclusions:Anti-HBc positive grafts can be safely given in recipients with protective anti-HBs titers. Cases of new HBV infection post anti-HBc positive graft transplants require careful virological surveillance along with an evaluation of immunological response. Post-transplant vaccination for HBV naïve recipients of anti-HBc positive liver grafts could be incorporated into the current guidelines.
Keyword(s): HBsAg, transplant immunology, HBV DNASession Type: 1-hour Oral Session
Session Title: 1-hour Oral Session
Authors(s): A. Gupta (1), N. Kumbhar (1), R. Agarwal (1), A. Choudhury (2), V. Pamecha (3), E. Gupta (1)
Authors Affiliations(s): (1) Department of Clinical Virology, Institute of Liver and Biliary Sciences, India, (2) Department of Hepatology, Institute of Liver and Biliary Sciences, India, (3) Department of Hepatobiliary Surgery and Liver Transplant, Institute of Liver and Biliary Sciences, India
Background:
Organ shortages in liver transplantation (LT) have led to an increase in the use of donors with hepatitis B (HBV) positive serology. However, the risk of acquiring new HBV infection in HBV naïve LT recipients from anti-HBc positive donors is substantial (38%-100%). Risks are found to be lower for recipients with anti-HBs titer >10 mIU/mL and highest in those with anti-HBs <10 mIU/mL or negative anti-HBc total.
Methods:In this retrospective study, from January 2015 to September 2019, recipients of anti-HBc positive liver grafts were followed up for the occurrence of HBV infection post LT.
Results:A total of 34 patients with a mean age of 40.8±14.4 years received anti-HBc positive liver grafts. All patients were male and the majority presented with chronic liver disease related to HBV (13, 38.2%) or alcoholic liver disease (13, 38.2%). All patients received tenofovir or entecavir prophylaxis for HBV and were followed up for a median of 10 months (range 2-34 months) post-transplant. Prior to LT, anti-HBc positive recipients were 19 (55.8%) and negative were 15 (44.1%). Post LT, HBV recurrence was not found in the anti-HBc positive recipient group. However, 2/15 (13.3%) cases of HBV occurrence were found among the anti-HBc negative recipients. On further analysis, these recipients were found to have pre LT anti-HBs titers of <10 mIU/mL. Interestingly, their donors had pre-LT anti-HBs titers of >100 mIU/mL, suggesting adequate protective antibodies. Both HBV naïve recipients were diagnosed with new HBV infection after 22 and 32 months post LT, despite adequate antiviral treatment. Serological markers (HBsAg, HBeAg) were found to be positive along with HBV viral load of 2.04x103 IU/ml and 6.80x107 IU/ml respectively in these cases.
Conclusions:Anti-HBc positive grafts can be safely given in recipients with protective anti-HBs titers. Cases of new HBV infection post anti-HBc positive graft transplants require careful virological surveillance along with an evaluation of immunological response. Post-transplant vaccination for HBV naïve recipients of anti-HBc positive liver grafts could be incorporated into the current guidelines.
Keyword(s): HBsAg, transplant immunology, HBV DNA