Blood, Vol. 96 No. 2 (July 15), 2000:
pp. 452-458
A case-controlled study on the use of HBsAg-positive donors for
allogeneic hematopoietic cell transplantation
George K. K. Lau,
Albert K. W. Lie,
Yok Lam Kwong,
Cheuk Kwong Lee,
Jinlin Hou,
Yu Lung Lau,
Wei Ling Lim, and
Raymond Liang
From the Division of Gastroenterology and Hepatology, Division of
Hematology, Department of Medicine, Department of Pediatrics and Virus
Unit, Queen Mary Hospital, Hong Kong; Department of Infectious Disease,
Nanfang Hospital, The First Medical College of PLA, Guangzhou, PR
China.
To compare the clinical and serological outcomes of patients
receiving donors' marrow positive or negative for hepatitis B surface
antigen (HBsAg), we studied 18 patients of allogeneic hematopoietic
cell transplantation receiving HBsAg-positive marrow (group 1) and 18 receiving HBsAg-negative marrow (group 2). The recipients of the 2 groups were matched for hepatitis B virus (HBV) serology, sex, age,
underlying hematological diseases, conditioning regimen, and
prophylaxis against graft-versus-host diseases. Eight (44.4%)
recipients in group 1 and 2 (11.1%) in group 2 suffered from
HBV-related hepatitis posttransplant (P = .03).
Furthermore, HBV-related hepatic failure was seen in 6 group 1 patients, but in none of the group 2 patients (P = .007).
Five of the 9 (55.5%) HBsAg-negative recipients in group 1 became
positive after receiving HBsAg-positive marrow. Serum HBV DNA was
positive in all 5 donors of these patients, but in none of the donors
of recipients who remained HBsAg negative (P = .008). Group
1 patients developing HBV-related hepatitis posttransplant were more
likely to have a donor carrying a precore A1896 and/or core
promoter T1762/A1764 HBV variant (62.5% versus
0%, P = .007). This study has demonstrated that a high
incidence of HBV-related hepatitis was associated with the use of
HBsAg-positive marrow for transplant, and a high viral load in the
donor appeared to predispose recipients to the development of
HBV-related hepatitis posttransplant. Further clinical trials will be
necessary to determine the optimal management approach to this problem,
including the use of the antiviral agents in the donors and the recipients.
