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World J Gastroenterol. Sep 21, 2016; 22(35): 8010-8016
Published online Sep 21, 2016. doi: 10.3748/wjg.v22.i35.8010
Liver grafts from hepatitis B surface antigen-positive donors: A review of the literature
Elisabetta Loggi, Fabio Conti, Alessandro Cucchetti, Giorgio Ercolani, Antonio Daniele Pinna, Pietro Andreone
Elisabetta Loggi, Fabio Conti, Alessandro Cucchetti, Giorgio Ercolani, Antonio Daniele Pinna, Pietro Andreone, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, 40138 Bologna, Italy
Pietro Andreone, Centro di Ricerca per lo Studio delle Epatiti, Università degli Studi di Bologna, 40138 Bologna, Italy
Author contributions: Loggi E and Conti F performed the literature search; Loggi E drafted the paper; Conti F, Cucchetti A and Ercolani G analyzed and interpreted the data; Pinna AD revised the paper critically for important intellectual content; and Andreone P designed the work and corrected the final version.
Conflict-of-interest statement: Nothing to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Pietro Andreone, MD, Professor of Internal Medicine, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi di Bologna, Via Massarenti, 9, 40138 Bologna, Italy. pietro.andreone@unibo.it
Telephone: +39-51-2143618 Fax: +39-51-345806
Received: March 26, 2016
Peer-review started: March 26, 2016
First decision: May 12, 2016
Revised: June 6, 2016
Accepted: July 21, 2016
Article in press: July 21, 2016
Published online: September 21, 2016
Abstract

The scarcity of available organs and the gap between supply and demand continue to be the main limitations of liver transplantation. To relieve the organ shortage, current transplant strategies have implemented extended criteria, which include the use of liver from patients with signs of past or present hepatitis B virus (HBV) infection. While the use of liver grafts from donors with evidence of past HBV infection is quite limited, some data have been collected regarding the feasibility of transplanting a liver graft from a hepatitis B surface antigen (HBsAg) positive donor. The aim of the present work was to review the literature regarding liver transplants from HBsAg-positive donors. A total of 17 studies were identified by a search in Medline. To date, HBsAg positive grafts have preferentially been allocated to HBsAg positive recipients. The large majority of these patients continue to be HBsAg positive despite the use of immunoglobulin, and infection prevention can only be guaranteed by using antiviral prophylaxis. Although serological persistence is evident, no significant HBV-related disease has been observed, except in patients coinfected with delta virus. Consistently less data are available for HBsAg negative recipients, although they are mostly promising. HBsAg-positive grafts could be an additional organ source for liver transplantation, provided that the risk of reinfection/reactivation is properly prevented.

Keywords: Liver transplantation, Hepatitis B, Marginal grafts, Hepatitis B positive graft, Hepatitis B surface antigen positive donor

Core tip: Organ shortage is the main problem of liver transplantation, and the use of marginal grafts could increase the donor pool. Data accumulated to date show that hepatitis B surface antigen-positive grafts could be an additional organ source for liver transplantation. The requirements that have to be fulfilled are the lack of a significant hepatitis B virus-disease of the graft, and the use of a proper prophylactic regimen, which is now largely available.