From the Guidelines
A person who is hepatitis B core (HBc) antibody positive can potentially be a stem cell donor, but additional testing is required to determine eligibility. The presence of hepatitis B core antibodies alone indicates past exposure to the hepatitis B virus, not necessarily active infection. Donors who are HBc antibody positive should undergo further testing, including hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), and hepatitis B viral DNA testing. If the donor is HBsAg negative and has undetectable viral DNA, they may be cleared to donate, especially if the recipient has immunity to hepatitis B 1. However, if the donor has active hepatitis B infection (HBsAg positive), they would typically be deferred. The transplant team weighs the risks and benefits on a case-by-case basis, considering factors such as the urgency of the transplant and the availability of alternative donors.
Some key considerations for donors who are HBc antibody positive include:
- The risk of transmitting hepatitis B to the recipient is low if the donor is HBsAg negative and has undetectable viral DNA 1
- Recipients of stem cells from HBc antibody positive donors may receive antiviral prophylaxis such as entecavir or tenofovir to prevent potential hepatitis B reactivation 1
- Close monitoring after transplantation is necessary to detect any potential hepatitis B reactivation 1
- Consultation with a hepatologist or infectious diseases specialist with transplant experience is recommended when considering accepting an organ from an anti-HBc+ or HBsAg+ donor 1
Overall, the decision to accept a stem cell donor who is HBc antibody positive should be made on a case-by-case basis, taking into account the individual circumstances of the donor and recipient, as well as the potential risks and benefits of the transplant.
From the Research
Eligibility of HBc Positive Persons as Stem Cell Donors
- A person who is hepatitis B core (HBc) antibody positive can be a stem cell donor, but certain precautions need to be taken to prevent the transmission of hepatitis B virus (HBV) to the recipient 2.
- The use of grafts from hepatitis B core antibody-positive donors is considered safe for HBV-negative recipients, provided that lifelong antiviral prophylaxis is administered 2.
- However, the decision to allow an HBc positive person to donate stem cells should be made on a case-by-case basis, taking into account the potential risks and benefits of the donation.
Evaluation of Donors
- All donors, including those who are HBc positive, must be carefully evaluated and fully informed prior to donation 3, 4.
- Donors must be able to provide informed consent without coercion or pressure, and must be evaluated for the potential to transmit infections and other diseases to the recipient 3, 4.
- The clinical, psychological, and social needs of donors must also be considered, particularly in the case of pediatric donors 3.
Prevention of HBV Transmission
- Antiviral prophylaxis, such as the use of nucleos(t)ide analogues, can be effective in preventing HBV recurrence after liver transplantation 5, 2.
- The combination of hepatitis B immunoglobulin (HBIG) and a high-barrier nucleos(t)ide analogue is considered the standard of care for prophylaxis against HBV recurrence after liver transplantation 2.
- However, the use of HBIG-free prophylactic regimens with entecavir or tenofovir has also shown promising outcomes in preventing HBV recurrence 2.