Hepatitis B reactivation in liver transplant recipients

To suggest guidelines for the management of liver transplant recipients received liver from a donor with serum past HBV infection signs, the results of liver transplants from a deceased donor (LT) performed from Sep 2000 to Dec 2022 were studied. At the time of LT HBsAg was seronegative in 848 out of 1031 cases. In 59 (7%) of these 848 recipients subsequently become HBsAg seropositive (median – 15 months). In 13 cases, the duration of patient follow-up did not allow to assess the outcome of the disease. The disappearance of HBsAg as a result of antiviral therapy was observed in 25 (54.3%); control over virus replication (HBsAg+/HBV-DNA) was obtained in 4 (8.7%) of 46 recipients. HBV DNA was persisted in 16 (34.8%) recipients. One patient died of fibrosing cholestatic hepatitis. We proposed an algorithm for choosing antiviral prophylaxis for liver recipients without HBsAg who received an anti-HBc+ organ. Conclusion. The lack of information about anti-HBcor in the liver donor leads to a lack of antiviral prevention of recipients, which leads to reactivation of infection in at least 9% of recipients in the first 2.5 years after LT. With timely diagnosis, hepatitis B de novo is amenable to antiviral therapy without significant progression of fibrosis or graft loss. Key words: de novo HBV infection, HBV reactivation, liver transplantation, nucleos(t)ide analogues, anti-HBc