Donor–recipient Hepatitis B serological patterns and post-transplant HBV events in pediatric living donor liver transplantation: a single-center retrospective cohort with a nested case series
- 1Department of Hepatobiliary Surgery Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China
- 2The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- 3Baoshenghu Community Health Service Center, Liangjia, Chongqing, China
Abstract
Background: The combined effects of donor hepatitis B core antibody (anti-HBc) status and recipient pre-transplant hepatitis B surface antibody (anti-HBs) levels on post-transplant HBV events remain unclear in pediatric living donor liver transplantation (LDLT).
Methods: We retrospectively analyzed pediatric LDLT recipients transplanted between May 2018 and June 2023. The primary outcome was the first post-transplant hepatitis B surface antigen (HBsAg)-positive result, with death treated as a competing event. Recipients were stratified by donor anti-HBc status and recipient anti-HBs level (≥100 vs <100 mIU/mL). Antiviral prophylaxis with entecavir (0.015 mg/kg once daily) was given only to recipients of anti-HBc-positive grafts, and hepatitis B immune globulin was not used. Cumulative incidence was compared using Gray’s test, and associated factors were evaluated using Fine–Gray regression.
Results: Among 229 recipients, 14 (6.1%) developed HBV events. Events occurred in 0 of 97 recipients with an anti-HBc-negative donor and anti-HBs ≥100 mIU/mL (G1), 3 of 67 with an anti-HBc-negative donor and anti-HBs <100 mIU/mL (G2), 2 of 29 with an anti-HBc-positive donor and anti-HBs ≥100 mIU/mL (G3), and 9 of 36 with an anti-HBc-positive donor and anti-HBs <100 mIU/mL (G4); the corresponding 5-year cumulative incidences were 0%, 4.5%, 6.9% and 25.0% (global Gray’s test, P<0.001). Donor anti-HBc positivity (sHR, 8.28; 95% CI, 2.27–30.28; P = 0.001) and recipient anti-HBs <100 mIU/mL (sHR, 6.02; 95% CI, 1.32–27.55; P = 0.021) were independently associated with HBV events, although the wide confidence intervals reflect the small number of events (n = 14) and the magnitude of these estimates should be interpreted with caution.
Conclusions: Donor anti-HBc positivity and low recipient pre-transplant anti-HBs were independently associated with post-transplant HBV events after pediatric LDLT. Combined donor–recipient serological stratification identified a clear risk gradient and may support risk-adapted HBV surveillance and prevention.
Related
- Metagenomic next-generation sequencing of matched donor–recipient pairs reveals pathogen transmission dynamics and informs antimicrobial therapy in liver transplantation: a retrospective cohort study
- Nudix hydrolase 15 deficiency and azathioprine toxicity in a liver transplant recipient: A case report
- Anti-N-Methyl-D-Aspartate Receptor Encephalitis Presenting as Acute Psychosis in a Renal Transplant Recipient Under Chronic Immunosuppression
- Agonal time in donation after circulatory death lung donors and associations with early recipient pulmonary allograft function and long-term post-transplant outcomes
- Diagnostic and Management Challenges in Mixed-Source MDR Sepsis in a Kidney Transplant Recipient with an Infected Sacral Pressure Ulcer Treated with VAC Therapy: A Case Report
BibTeX
@article{le2026donorrecipient,
title = {{Donor–recipient Hepatitis B serological patterns and post-transplant HBV events in pediatric living donor liver transplantation: a single-center retrospective cohort with a nested case series}},
author = {Ying Le and Haifeng Tang and Quanhai Zhang and Jiajun Weng and Lianbin Huang and Xiaoke Dai and Mingman Zhang},
journal = {Frontiers in Immunology},
year = {2026},
month = oct,
doi = {10.3389/fimmu.2026.1977829},
url = {https://doi.org/10.3389/fimmu.2026.1977829},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Donor–recipient Hepatitis B serological patterns and post-transplant HBV events in pediatric living donor liver transplantation: a single-center retrospective cohort with a nested case series
AU - Ying Le
AU - Haifeng Tang
AU - Quanhai Zhang
AU - Jiajun Weng
AU - Lianbin Huang
AU - Xiaoke Dai
AU - Mingman Zhang
PY - 2026
DA - 2026/10/12
JO - Frontiers in Immunology
DO - 10.3389/fimmu.2026.1977829
UR - https://doi.org/10.3389/fimmu.2026.1977829
AB - Background: The combined effects of donor hepatitis B core antibody (anti-HBc) status and recipient pre-transplant hepatitis B surface antibody (anti-HBs) levels on post-transplant HBV events remain unclear in pediatric living donor liver transplantation (LDLT). Methods: We retrospectively analyzed pediatric LDLT recipients transplanted between May 2018 and June 2023. The primary outcome was the first post-transplant hepatitis B surface antigen (HBsAg)-positive result, with death treated as a competing event. Recipients were stratified by donor anti-HBc status and recipient anti-HBs level (≥100 vs <100 mIU/mL). Antiviral prophylaxis with entecavir (0.015 mg/kg once daily) was given only to recipients of anti-HBc-positive grafts, and hepatitis B immune globulin was not used. Cumulative incidence was compared using Gray’s test, and associated factors were evaluated using Fine–Gray regression. Results: Among 229 recipients, 14 (6.1%) developed HBV events. Events occurred in 0 of 97 recipients with an anti-HBc-negative donor and anti-HBs ≥100 mIU/mL (G1), 3 of 67 with an anti-HBc-negative donor and anti-HBs <100 mIU/mL (G2), 2 of 29 with an anti-HBc-positive donor and anti-HBs ≥100 mIU/mL (G3), and 9 of 36 with an anti-HBc-positive donor and anti-HBs <100 mIU/mL (G4); the corresponding 5-year cumulative incidences were 0%, 4.5%, 6.9% and 25.0% (global Gray’s test, P<0.001). Donor anti-HBc positivity (sHR, 8.28; 95% CI, 2.27–30.28; P = 0.001) and recipient anti-HBs <100 mIU/mL (sHR, 6.02; 95% CI, 1.32–27.55; P = 0.021) were independently associated with HBV events, although the wide confidence intervals reflect the small number of events (n = 14) and the magnitude of these estimates should be interpreted with caution. Conclusions: Donor anti-HBc positivity and low recipient pre-transplant anti-HBs were independently associated with post-transplant HBV events after pediatric LDLT. Combined donor–recipient serological stratification identified a clear risk gradient and may support risk-adapted HBV surveillance and prevention.
SN - 1664-3224
ER -