Indian Journal of Gastroenterology

, Volume 37, Issue 1, pp 39–43 | Cite as

Utilization of hepatitis B core antibody positive grafts in living donor liver transplantation

  • Visagh Puthumana Udayakumar
  • Sudhindran Surendran
  • Uma Devi PadmaEmail author
Original Article



Utilization of liver grafts from hepatitis B core antibody (anti-HBc) positive donors carries the risk of reactivation of hepatitis B virus (HBV) in recipients because of post-transplant immunosuppressive therapy.


This was a retrospective study of patients who had received liver grafts from anti-HBc positive live donors between 2006 and 2016 at our institute.


Out of 22 recipients [all males, mean age 45.4 years (range 18–64 years)], four patients were hepatitis B surface antigen (HBsAg) positive preoperatively and received entecavir post-transplantation. One among these patients who temporarily stopped entecavir had a recurrence of hepatitis B 39 months post-transplantation. Among the 13 non-immune [hepatitis B surface antibody (anti-HBs) < 10 mIU/mL] recipients, eight were prescribed lamivudine (100 mg daily) as monoprophylaxis. Four compliant patients remain negative for HBV so far. Out of the remaining four, two died secondary to sepsis unrelated to hepatitis B; two were non-compliant and developed reactivation of hepatitis B. Lamivudine was missed out in five non-immune patients; three of them developed hepatitis B reactivation while two remain negative. Anti-HBs titer was immune in five patients. Over a period of 4 to 8 years follow up, three remain immune without prophylaxis, while two expired due to causes unrelated to hepatitis B. Following the detection of hepatitis B infection, five patients have been started on tenofovir 300 mg once daily.


Anti-HBc positive liver grafts can be safely used for live donor liver transplantation. If the recipients are immune preoperatively, they can be merely followed up without HBV prophylaxis. However, it is extremely important to prophylactically treat the non-immune recipients with an antiviral agent lifelong.


Antiviral prophylaxis Nucleos(t)ide analogues Post-transplant HBV infection 



This work was supported by a project grant from Kerala State Council for Science, Technology and Environment (KSCSTE).

Author contributions

Visagh PU was involved in collecting data, analyzing data, and preparing the initial draft of the manuscript.

Sudhindran S was involved in study concept and protocol design, analysis of data, and critical revision of the manuscript for intellectual content.

Uma Devi P was involved in protocol design, analysis of data, and critical revision of the manuscript for intellectual content.

Compliance with ethical standards

Source of support

Kerala State Council for Science, Technology, and Environment (KSCSTE).

Conflict of interest

VPU, SS, and UDP declare that they have no conflict of interest.

Ethics statement

The study was conducted according to the Helsinki declaration, and the protocol was approved by the Institutional Ethics Committee (IEC-AIMS-2017-PHRM-027).


  1. 1.
    Soin AS, Thiagarajan S. Liver transplant scene in India. MAMC J Med Sci. 2016;2:6–11.CrossRefGoogle Scholar
  2. 2.
    Narasimhan G. Living donor liver transplantation in India. Hepatobiliary Surg Nutr. 2016;5:127–32.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Puri P. Tackling the hepatitis B disease burden in India. J Clin Exp Hepatol. 2014;4:312–9.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Dickson RC, Everhart JE, Lake JR, et al. Transmission of hepatitis B by transplantation of livers from donors positive for antibody to hepatitis B core antigen. The National Institute of Diabetes and Digestive and Kidney Diseases liver transplantation database. Gastroenterology. 1997;113:1668–74.Google Scholar
  5. 5.
    Kim HY, Choi JY, Park CH, et al. Adult living donor liver transplantation using hepatitis B core antibody- positive grafts in Korea, a hepatitis B endemic region. Gut Liver. 2011;5:363–6.Google Scholar
  6. 6.
    MacConmara MP, Vachharajani N, Wellen JR, et al. Utilization of hepatitis B core antibody-positive donor liver grafts. HPB (Oxford). 2012;14:42–8.Google Scholar
  7. 7.
    Cholongitas E, Papatheodoridis GV, Burroughs AK. Liver grafts from anti-hepatitis B core positive donors: a systematic review. J Hepatol. 2010;52:272–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Sudhindran S, Aboobacker S, Menon RN, Unnikrishnan G, Sudheer OV, Dhar P. Cost and efficacy of immunosuppression using generic products following living donor liver transplantation in India. Indian J Gastroenterol. 2012;31:20–3.CrossRefPubMedGoogle Scholar
  9. 9.
    Sunny L, James E, Krishnapriya M, Mamatha MR, Sudhindran S. Evaluation of factors influencing renal dysfunction following living donor liver transplantation. Indian J Pharm Sci. 2016;78:566–74.CrossRefGoogle Scholar
  10. 10.
    de Villa VH, Chen YS, Chen CL. Hepatitis B core antibody-positive grafts: recipient’s risk. Transplantation. 2003;753 Suppl:S49–53.Google Scholar
  11. 11.
    Vizzini G, Gruttadauria S, Volpes R, et al. Lamivudine monoprophylaxis for de novo HBV infection in HBsAg-negative recipients with HBcAb-positive liver grafts. Clin Transpl. 2011;25:E77–81.Google Scholar
  12. 12.
    Tur-Kaspa R, Burk RD, Shaul Y, Shafritz DA, Hepatitis B. Virus DNA contains a glucocorticoid-responsive element. Proc Natl Acad Sci U S A. 1986;83:1627–31.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Fischer KP, Gutfreund KS, Tyrrell DL. Lamivudine resistance in hepatitis B: mechanisms and clinical implications. Drug Resist Updat. 2001;4:118–28.CrossRefPubMedGoogle Scholar
  14. 14.
    Huprikar S, Danziger-Isakov L, Ahn J, et al. Solid organ transplantation from hepatitis B virus-positive donors: consensus guidelines for recipient management. Am J Transplant. 2015;15:1162–72.Google Scholar

Copyright information

© Indian Society of Gastroenterology 2018

Authors and Affiliations

  • Visagh Puthumana Udayakumar
    • 1
  • Sudhindran Surendran
    • 2
  • Uma Devi Padma
    • 3
    Email author
  1. 1.Department of Pharmacy PracticeAmrita School of Pharmacy, Amrita Vishwa VidyapeethamKochiIndia
  2. 2.Department of Gastrointestinal SurgeryAmrita Institute of Medical Sciences, Amrita Vishwa VidyapeethamKochiIndia
  3. 3.Department of PharmacologyAmrita School of Pharmacy, Amrita Vishwa VidyapeethamKochiIndia

Personalised recommendations