From the Guidelines
A person who is Hepatitis B core antibody positive (HBcore+) and Hepatitis B surface antigen negative (HBsAg-) can be a stem cell donor, but it is crucial to conduct thorough testing and take necessary precautions to prevent Hepatitis B reactivation in the recipient. This serological pattern typically indicates past Hepatitis B infection with clearance of the virus, as suggested by the guidelines for management of chronic hepatitis B 1. The absence of HBsAg suggests the person is not currently infectious. However, the risk of reactivation, especially in immunocompromised recipients, necessitates careful management.
Before donation, the potential donor should undergo further testing, including:
- Hepatitis B viral DNA testing to confirm there is no active viral replication
- Hepatitis B surface antibody (anti-HBs) levels to assess immunity These tests are essential for evaluating the risk of Hepatitis B reactivation and guiding the management of the recipient, as recommended by recent clinical practice guidelines 1.
The recipient may need prophylactic antiviral medication, such as entecavir or tenofovir, to prevent potential Hepatitis B reactivation, especially if they are immunocompromised 1. The choice of antiviral agent should be based on the presence of a high resistance barrier, with entecavir, tenofovir DF, or tenofovir AF being preferred options 1. The duration of prophylactic antiviral therapy should be determined on a case-by-case basis, considering the risk of reactivation and the individual's immune status, with some guidelines suggesting continuation for at least 6-12 months after completion of immunosuppressive therapy 1.
Key considerations for stem cell donation from HBcore+ and HBsAg- individuals include:
- Thorough testing to assess the risk of Hepatitis B reactivation
- Prophylactic antiviral therapy for the recipient to prevent reactivation
- Individualized evaluation of the risks and benefits of donation
- Close monitoring of the recipient for signs of Hepatitis B reactivation By taking these precautions, many previously infected individuals can safely donate stem cells while protecting recipients through appropriate preventive measures, as supported by recent studies and guidelines 1.
From the Research
Eligibility of HBcore Antibody Positive and HBsAg Negative Person as a Stem Cell Donor
- A person who is HBcore antibody positive and HBsAg negative can be considered as a stem cell donor, but the risk of transmitting hepatitis B virus (HBV) to the recipient should be carefully evaluated 2, 3.
- Studies have shown that liver donors with serological evidence of resolved HBV infection (HBsAg negative, anti-HBV core positive) can transmit HBV infection to recipients 2.
- However, the risk of HBV reactivation in recipients of hematopoietic stem cell transplants from donors with resolved HBV infection is relatively low, and the outcome of these patients is not significantly different from those with negative serology for HBV 3.
Risk of HBV Reactivation
- The risk of HBV reactivation in recipients of stem cell transplants from donors with resolved HBV infection is higher in patients with extensive chronic graft-versus-host disease (cGVHD) and in those with donors lacking hepatitis B surface antibody 4.
- The cumulative incidence of HBV reactivation in patients with resolved HBV infection after allogeneic hematopoietic stem cell transplantation is around 8-11% at 3 years 4, 3.
- Antiviral treatment can reduce the risk of HBV reactivation, but the emergence of drug-resistant mutations is a concern 5, 6.
Donor Selection and Prophylaxis
- The selection of donors with resolved HBV infection should be based on a careful evaluation of the risk of HBV reactivation and the potential benefits of the transplant 4.
- Prophylaxis with hepatitis B immunoglobulin (HBIG) or antiviral therapy may be considered to prevent HBV reactivation in recipients of stem cell transplants from donors with resolved HBV infection 2, 5.