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Truly de novo Hepatitis B After Liver Transplantation

TO THE EDITOR: We have read the article by BarcenaMarugan et al. (1) with interest reporting that vaccination against hepatitis B virus (HBV) in patients who are candidates for liver transplantation is fundamental in order to avoid cases of de novo hepatitis B after transplantation. De novo hepatitis B after liver transplantation has raised increasing concern in recent years. It is relatively uncommon, affecting 2–7% of liver recipients (1–8), but may be associated with increased morbidity and mortality (5–7). Several studies conclude that the main source of de novo hepatitis B after liver transplantation is anti-HBc-positive donors, particularly if they are anti-HBs-negative (2–5, 7, 8). For this reason, antiHBc-positive donors are either currently rejected or employed for selected candidates under specific antiviral prophylaxis (8, 9). Barcena-Marugan et al. reported that no case of de novo hepatitis B was detected in patients who had HBV markers prior to transplantation (from either past infection or vaccination), while a 14.5% risk of de novo hepatitis B was detected in patients without HBV markers (1). Here we present our experience in a series of liver transplant patients, in order to emphasize (a) that not only anti-HBc-positive donors are the source of de novo hepatitis B, and (b) the need for HBV prophylactic measures. From June 1994 to December 1999, 153 patients received a liver allograft in our center. The study was focused on the 145 recipients (109 males, median age: 51 yr, range: 12–67 yr) that were HBsAg-negative before transplantation. Liver cirrhosis was the main indication for transplantation (124 cases, 86%). A history of alcohol abuse and HCV infection were present in 94 and 33 recipients, respectively. Ten patients needed retransplantation. During the study period, livers from HBsAg-positive donors were rejected for trans-