From the Guidelines
A person with a history of hepatitis B infection who is hepatitis B core antibody positive, HBV DNA negative, and HBsAg negative can generally be a stem cell donor, but the recipient may require prophylactic antiviral therapy to prevent potential reactivation. This serological profile indicates past infection with complete viral clearance and no active viral replication, as noted in studies such as 1. The absence of HBsAg and undetectable HBV DNA means the individual is not currently infectious. However, the donor should undergo comprehensive evaluation before donation, including liver function tests to ensure normal hepatic function. The recipient may require prophylactic antiviral therapy such as entecavir or tenofovir to prevent potential reactivation, especially if they will undergo immunosuppressive conditioning, as recommended by 1. This preventive approach is important because even with undetectable viral levels, trace amounts of HBV DNA can potentially remain in the liver and reactivate under immunosuppression. Some key considerations for donor selection and management include:
- Comprehensive evaluation of the donor before donation, including liver function tests
- Prophylactic antiviral therapy for the recipient to prevent potential reactivation
- Monitoring of both donor and recipient before and after the procedure to ensure safety and optimal outcomes, as discussed in 1 and 1. The risk of transmission is considered low in this scenario, but careful monitoring and management are essential to minimize this risk, as noted in 1.
From the Research
Eligibility of HBc Positive, HBV DNA Negative, HBsAg Negative Person as a Stem Cell Donor
- A person with a history of hepatitis B (HB) infection, who is hepatitis B core (HBc) antibody positive, hepatitis B virus (HBV) deoxyribonucleic acid (DNA) negative, and hepatitis B surface antigen (HBsAg) negative, may be considered as a stem cell donor.
- According to the study 2, hematopoietic stem cell transplantation from non-replicative hepatitis B virus carriers is safe, suggesting that individuals with resolved HBV infection can be donors.
- However, the risk of HBV reactivation in the recipient should be considered, as shown in the study 3, which reported a high risk of viral reactivation even in a recipient with a vaccinated donor.
- The study 4 found that adoptive immunity transfer from the donor seems to have protective effects against HBV reactivation, and combined with extensive chronic graft-versus-host disease (cGVHD) provides a good target for risk-adaptive HBV prophylaxis.
- The presence of HBsAg positivity is not an absolute contraindication for allogeneic hematopoietic stem cell transplantation, as stated in the study 5.
- A novel strategy for the prevention of HBV-related hepatitis following allogeneic hematopoietic stem cell transplantation from HBsAg-positive donors has been proposed, which includes antiviral treatment, hepatitis B immune globulin (HBIG) administration, and prophylactic antiviral treatment 6.
- In summary, a person with a history of HBV infection who is HBc positive, HBV DNA negative, and HBsAg negative can be considered as a stem cell donor, but the risk of HBV reactivation in the recipient should be carefully evaluated and managed, as suggested by the studies 5, 3, 4, 2, 6.