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Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE
Yong Chan Lee |
Professor of Medicine Director, Gastrointestinal Research Laboratory Veterans Affairs Medical Center, Univ. California San Francisco San Francisco, USA |
Jong Pil Im | Seoul National University College of Medicine, Seoul, Korea |
Robert S. Bresalier | University of Texas M. D. Anderson Cancer Center, Houston, USA |
Steven H. Itzkowitz | Mount Sinai Medical Center, NY, USA |
All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
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Hee Yeon Kim*, Jong Young Choi**, Chung-Hwa Park*, Myeong Jun Song*, Jeong Won Jang*, U Im Chang*, Si Hyun Bae*, Seung Kew Yoon*, Joon Yeol Han*, and Dong Goo Kim†
*Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
†Department of Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea.
Correspondence to: Jong Young Choi. Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, 505 Banpo-dong, Seocho-gu, Seoul 137-040, Korea. Tel: +82-2-2258-2073, Fax: +82-2-3481-4025, jychoi@catholic.ac.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Gut Liver 2011;5(3):363-366. https://doi.org/10.5009/gnl.2011.5.3.363
Published online August 18, 2011, Published date September 30, 2011
Copyright © Gut and Liver.
The exclusion of hepatitis B core antibody (HBcAb)-positive donors from liver transplants (LTs) due to the risk of transmitting hepatitis B virus (HBV) does not appear to be practical in Korea, where hepatitis B is endemic. This study assessed the risk of
Of 341 adult living donor LTs conducted at our institution between March 2001 and September 2008, 176 donors (51.6%) were HBcAb-positive, and 26 HBcAb-positive grafts were transplanted to HBsAg-negative recipients. The median follow-up time after LT was 41.9 months.
Without anti-HBV prophylaxis, 2 out of 26 (7.7%) HBsAg-negative recipients who received grafts from HBcAb-positive donors developed
Keywords:
Owing to the discordance between the increment of potential recipients for liver transplantation (LT) and a lack of available liver donors, there has been increased use of hepatitis B core antibody (HBcAb)-positive liver grafts.1,2 However, liver grafts from HBcAb-positive donors carry the risk of transmitting hepatitis B virus (HBV) to hepatitis B surface antigen (HBsAg)-negative recipients since occult HBV infection in the liver grafts can be reactivated in the recipient through the use of posttransplant immunosuppression.3-6
Because Korea is endemic for HBV and the rate of HBcAb positivity among liver donors reflects the prevalence of HBV infection,3 the prevalence of HBcAb positivity in Korea is greater than that of well-known low prevalence areas.7 Accumulated experiences strongly recommend the administration of preventive therapy for HBV-naïve recipients who receive grafts from HBcAb-positive donors, and anti-HBV prophylaxis is suggested to vaccinated recipients or the ones with isolated HBcAb.8,9 However, it is uncertain if it is suitable to apply these treatments equally in HBV endemic areas. Thus, this study was conducted to evaluate the risk of
From March 2001 to September 2008, 341 consecutive adult living donor liver transplantations (LDLT) were conducted at our institution. The median age of the 341 donors was 31 years, and 176 donors (51.6%) were HBcAb-positive. Only 65 of the 341 recipients were HBsAg-negative previous to LT. All recipients were followed-up for at least 15 months after LT.
Among 65 HBsAg-negative recipients, nine were naïve for HBV (HBcAb-negative, Hepatitis B surface antibody [HBsAb]-negative), 11 were only HBsAb-positive, indicating that they had been previously vaccinated, 39 were positive for both HBcAb and HBsAb, indicating previous infection, and six were only positive for HBcAb. In the recipient population, the positive rate of HBcAb was 69.2% (45/65). The median age of the 65 HBsAg-negative recipients was 51 years, and 26 of these 65 recipients received HBcAb-positive grafts (Fig. 1). None of the HBsAg-negative recipients receiving liver grafts from HBcAb-positive donors had received preventive therapy against
Instead of anti-HBV prophylaxis, recipients were routinely screened for serum HBsAg and HBV DNA at least every 3 months or whenever graft dysfunction was suspected after LT. The median follow-up period after LT was 41.9 months (range, 15 to 103 months).
This study was conducted according to the current declaration of Helsinki, and the protocol was approved by the Institutional Ethics Committee at Seoul St. Mary's Hospital in Korea. Baseline clinical and serologic markers were assessed. Continuous variables were expressed as medians with ranges and were compared using the Mann-Whitney U-test. Categorical variables were expressed as the number of patients with percentage and were compared using the chi-square or the Fisher's exact tests where appropriate. p-value less than 0.05 was considered to be significant. Software package SPSS version 14.0 (SPSS Inc., Chicago, IL, USA) was used for all statistical analyses.
The baseline characteristics of the 65 HBsAg-negative recipients are shown in Table 1. Without any prophylaxis, two out of the 26 (7.7%) HBsAg-negative recipients who received the graft from HBcAb-positive donors developed
It has been reported that
Conversely, development of
As described above, there were no abnormalities in liver function tests upon diagnosis for
While the median follow-up time was 41.9 months with a maximum of 103 months,
In Korea, HBsAg-positive patients have mainly comprised adult LT recipient population. Therefore, reports about HBsAg-negative recipients from HBcAb-positive donors has been limited. In our study, 19% (65/341) of adult LDLTs have not been attributed to HBV. Despite the limited cases, this study has the implication that the study population structure was different from that of Western series. About half of LT recipients in other studies conducted in areas with low prevalence of HBV consisted of HBV-naïve recipients. But, only about 15% of LT recipients were HBV-naïve in our series. To draw more conclusive results in different population, multicenter prospective studies will be needed.
In conclusion,
LDLT, living donor liver transplantation; HBsAg, hepatitis B surface antigen; HBcAb, hepatitis B core antibody; HBsAb, hepatitis B surface antibody; HBV, Hepatitis B virus.
Continuous variables are expressed as the median (range).
HBsAg, hepatitis B surface antigen; HBcAb, hepatitis B core antibody; HBsAb, hepatitis B surface antibody; HAV, hepatitis A virus; HCV, hepatitis C virus; Alc, alcohol.
HBsAg, hepatitis B surface antigen; HBcAb, hepatitis B core antibody; HBsAb, hepatitis B surface antibody; HAV, hepatitis A virus; HCV, hepatitis C virus; Alc, alcohol.
Gut Liver 2011; 5(3): 363-366
Published online September 30, 2011 https://doi.org/10.5009/gnl.2011.5.3.363
Copyright © Gut and Liver.
Hee Yeon Kim*, Jong Young Choi**, Chung-Hwa Park*, Myeong Jun Song*, Jeong Won Jang*, U Im Chang*, Si Hyun Bae*, Seung Kew Yoon*, Joon Yeol Han*, and Dong Goo Kim†
*Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
†Department of Surgery, The Catholic University of Korea College of Medicine, Seoul, Korea.
Correspondence to: Jong Young Choi. Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, 505 Banpo-dong, Seocho-gu, Seoul 137-040, Korea. Tel: +82-2-2258-2073, Fax: +82-2-3481-4025, jychoi@catholic.ac.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
The exclusion of hepatitis B core antibody (HBcAb)-positive donors from liver transplants (LTs) due to the risk of transmitting hepatitis B virus (HBV) does not appear to be practical in Korea, where hepatitis B is endemic. This study assessed the risk of
Of 341 adult living donor LTs conducted at our institution between March 2001 and September 2008, 176 donors (51.6%) were HBcAb-positive, and 26 HBcAb-positive grafts were transplanted to HBsAg-negative recipients. The median follow-up time after LT was 41.9 months.
Without anti-HBV prophylaxis, 2 out of 26 (7.7%) HBsAg-negative recipients who received grafts from HBcAb-positive donors developed
Keywords:
Owing to the discordance between the increment of potential recipients for liver transplantation (LT) and a lack of available liver donors, there has been increased use of hepatitis B core antibody (HBcAb)-positive liver grafts.1,2 However, liver grafts from HBcAb-positive donors carry the risk of transmitting hepatitis B virus (HBV) to hepatitis B surface antigen (HBsAg)-negative recipients since occult HBV infection in the liver grafts can be reactivated in the recipient through the use of posttransplant immunosuppression.3-6
Because Korea is endemic for HBV and the rate of HBcAb positivity among liver donors reflects the prevalence of HBV infection,3 the prevalence of HBcAb positivity in Korea is greater than that of well-known low prevalence areas.7 Accumulated experiences strongly recommend the administration of preventive therapy for HBV-naïve recipients who receive grafts from HBcAb-positive donors, and anti-HBV prophylaxis is suggested to vaccinated recipients or the ones with isolated HBcAb.8,9 However, it is uncertain if it is suitable to apply these treatments equally in HBV endemic areas. Thus, this study was conducted to evaluate the risk of
From March 2001 to September 2008, 341 consecutive adult living donor liver transplantations (LDLT) were conducted at our institution. The median age of the 341 donors was 31 years, and 176 donors (51.6%) were HBcAb-positive. Only 65 of the 341 recipients were HBsAg-negative previous to LT. All recipients were followed-up for at least 15 months after LT.
Among 65 HBsAg-negative recipients, nine were naïve for HBV (HBcAb-negative, Hepatitis B surface antibody [HBsAb]-negative), 11 were only HBsAb-positive, indicating that they had been previously vaccinated, 39 were positive for both HBcAb and HBsAb, indicating previous infection, and six were only positive for HBcAb. In the recipient population, the positive rate of HBcAb was 69.2% (45/65). The median age of the 65 HBsAg-negative recipients was 51 years, and 26 of these 65 recipients received HBcAb-positive grafts (Fig. 1). None of the HBsAg-negative recipients receiving liver grafts from HBcAb-positive donors had received preventive therapy against
Instead of anti-HBV prophylaxis, recipients were routinely screened for serum HBsAg and HBV DNA at least every 3 months or whenever graft dysfunction was suspected after LT. The median follow-up period after LT was 41.9 months (range, 15 to 103 months).
This study was conducted according to the current declaration of Helsinki, and the protocol was approved by the Institutional Ethics Committee at Seoul St. Mary's Hospital in Korea. Baseline clinical and serologic markers were assessed. Continuous variables were expressed as medians with ranges and were compared using the Mann-Whitney U-test. Categorical variables were expressed as the number of patients with percentage and were compared using the chi-square or the Fisher's exact tests where appropriate. p-value less than 0.05 was considered to be significant. Software package SPSS version 14.0 (SPSS Inc., Chicago, IL, USA) was used for all statistical analyses.
The baseline characteristics of the 65 HBsAg-negative recipients are shown in Table 1. Without any prophylaxis, two out of the 26 (7.7%) HBsAg-negative recipients who received the graft from HBcAb-positive donors developed
It has been reported that
Conversely, development of
As described above, there were no abnormalities in liver function tests upon diagnosis for
While the median follow-up time was 41.9 months with a maximum of 103 months,
In Korea, HBsAg-positive patients have mainly comprised adult LT recipient population. Therefore, reports about HBsAg-negative recipients from HBcAb-positive donors has been limited. In our study, 19% (65/341) of adult LDLTs have not been attributed to HBV. Despite the limited cases, this study has the implication that the study population structure was different from that of Western series. About half of LT recipients in other studies conducted in areas with low prevalence of HBV consisted of HBV-naïve recipients. But, only about 15% of LT recipients were HBV-naïve in our series. To draw more conclusive results in different population, multicenter prospective studies will be needed.
In conclusion,
LDLT, living donor liver transplantation; HBsAg, hepatitis B surface antigen; HBcAb, hepatitis B core antibody; HBsAb, hepatitis B surface antibody; HBV, Hepatitis B virus.
Table 1 Baseline Characteristics of 65 HBsAg-Negative Recipients
Continuous variables are expressed as the median (range).
HBsAg, hepatitis B surface antigen; HBcAb, hepatitis B core antibody; HBsAb, hepatitis B surface antibody; HAV, hepatitis A virus; HCV, hepatitis C virus; Alc, alcohol.
HBsAg, hepatitis B surface antigen; HBcAb, hepatitis B core antibody; HBsAb, hepatitis B surface antibody; HAV, hepatitis A virus; HCV, hepatitis C virus; Alc, alcohol.