Prediction of occult hepatitis B virus infection in liver transplant donors through hepatitis B virus blood markers

Background: Occult hepatitis B virus infection is defined as detectable HBV-DNA in liver of HBsAgnegative individuals, with or without detectable serum HBV-DNA. In deceased liver donors, results of tissue analysis cannot be obtained prior to allocation for liver transplantation. Aims: we investigated prevalence and predictability of occult hepatitis B using blood markers of viral exposure/infection in deceased liver donors. Methods: In 50 consecutive HBsAg-negative/anti-HBc-positive and 20 age-matched HBsAg-negative/antiHBc-negative donors, a nested-PCR assay was employed in liver biopsies for diagnosis of occult hepatitis B according to Taormina criteria. All donors were characterized for plasma HBV-DNA and serum antiHBs/ anti-HBe. Results: In liver tissue, occult hepatitis B was present in 30/50 anti-HBc-positive (60%) and in 0/20 antiHBc- negative donors (p < 0.0001). All anti-HBc-positive donors with detectable HBV-DNA in plasma (n = 5) or anti-HBs > 1,000 mIU/mL (n = 5) eventually showed occult infection, i. e, 10/30 occult hepatitis B-positive donors which could have been identified prior to transplantation. In the remaining 40 anti-HBc-positive donors, probability of occult infection was 62% for anti-HBe-positive and/or antiHBs = 58 mIU/mL; 29% for anti-HBe-negative and anti-HBs < 58 mIU/mL. Conclusions: In deceased donors, combining anti-HBc with other blood markers of hepatitis B exposure/ infection allows to predict occult hepatitis B with certainty and speed in one third of cases. These findings might help refine the allocation of livers from anti-HBc-positive donors. (C) 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.