De-novo hepatitis B virus infection in transplants: Risk factors and anti-hepatitis B immunoglobulin prophylaxis

The dramatic increase of transplantation activity in the last years has been related to the increase of eligible donors and to the use of “marginal grafts” from aged donors or even from hepatitis B virus (HBV) infected patients in emergencies. Hepatitis B after transplantation is related to the appearance of HBsAg in subjects originally positive (reactivation) or negative (de-novo hepatitis B, DNHB). DNHB can be influenced by: a) transmission from donors who are carriers of occult B infection (OBI); b) reactivation in recipients who are carriers of OBI; c) by HBV infection from HBsAg-positive donors. Hepatitis B immunoglobulin (HBIG) and antiviral(s) have become the standard of care after liver transplantation (LT) worldwide, changing the long-term outcome of HBsAg-positive recipients. In HBsAg-negative recipients HBIGs maintain an important role in the peri-operative and long-term period after liver transplantation for prevention of DNHB from OBI donors; in other transplants hepatitis B reactivation from OBI carriers (donors or recipients) remains an uncommon event and the role of prophylaxis is controversial. Data related to HBV infection and DNHB in solid organs and bone marrow transplantation are reviewed.