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Background <p>The utilization of liver grafts from hepatitis B core antibody (HBcAb)-positive donors is relatively common in regions with high hepatitis B virus (HBV) prevalence. This practice poses a potential risk of HBV transmission. However, the impact of these grafts on pediatric liver transplant recipients is not well-established.</p> Method <p>To address these knowledge gaps, we conducted a prospective observational cohort study to assess the risk of post-transplant HBV transmission in pediatric recipients of HBcAb-positive grafts. Hepatitis B serology and liver tissue analyses for HBV DNA were performed during post-transplantation follow-up of 188 pediatric recipients.</p> Results <p>In the cohort study, 43 pediatric recipients (22.9%) received HBcAb-positive grafts, while 145 (77.1%) received HBcAb-negative grafts. Over a median follow-up of 43 weeks, 10 recipients (5.3% of the total cohort) developed HBV infection. The cumulative incidence of de novo HBV infection was significantly higher in recipients of HBcAb-positive grafts (18%, 95% CI: 5–31) compared to recipients of HBcAb-negative grafts (3%, 95% CI: 0–6, <i>p</i> &lt; 0.05). Notably, higher levels of hepatitis B surface antibody (HBsAb ≥ 100mIU/ml) in pediatric recipients were associated with a significantly reduced risk of post-transplant de novo HBV infection (<i>p</i> &lt; 0.05).</p> Conclusion <p>HBcAb-positive grafts substantially increase HBV transmission risk in pediatric liver transplantation. Elevated HBsAb titers may mitigate infection severity, while occult HBV infections require vigilant monitoring. Strategic enhancement of recipient HBsAb levels and optimized prophylactic protocols are critical for improving outcomes.</p>

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Risk of HBV transmission from HBcAb-positive grafts in pediatric liver transplantation: a real-world prospective cohort study

  • 期刊论文

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  • 发表日期：

    2025年9月29日

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  • Yuting Yang,
  • Guojin Wu,
  • Xiaoke Dai,
  • Tengteng Zhang,
  • Bingqian Tan,
  • Yue Lu,
  • Mingman Zhang,
  • Yao Zhao

摘要

Background

The utilization of liver grafts from hepatitis B core antibody (HBcAb)-positive donors is relatively common in regions with high hepatitis B virus (HBV) prevalence. This practice poses a potential risk of HBV transmission. However, the impact of these grafts on pediatric liver transplant recipients is not well-established.

Method

To address these knowledge gaps, we conducted a prospective observational cohort study to assess the risk of post-transplant HBV transmission in pediatric recipients of HBcAb-positive grafts. Hepatitis B serology and liver tissue analyses for HBV DNA were performed during post-transplantation follow-up of 188 pediatric recipients.

Results

In the cohort study, 43 pediatric recipients (22.9%) received HBcAb-positive grafts, while 145 (77.1%) received HBcAb-negative grafts. Over a median follow-up of 43 weeks, 10 recipients (5.3% of the total cohort) developed HBV infection. The cumulative incidence of de novo HBV infection was significantly higher in recipients of HBcAb-positive grafts (18%, 95% CI: 5–31) compared to recipients of HBcAb-negative grafts (3%, 95% CI: 0–6, p < 0.05). Notably, higher levels of hepatitis B surface antibody (HBsAb ≥ 100mIU/ml) in pediatric recipients were associated with a significantly reduced risk of post-transplant de novo HBV infection (p < 0.05).

Conclusion

HBcAb-positive grafts substantially increase HBV transmission risk in pediatric liver transplantation. Elevated HBsAb titers may mitigate infection severity, while occult HBV infections require vigilant monitoring. Strategic enhancement of recipient HBsAb levels and optimized prophylactic protocols are critical for improving outcomes.