• Kah Wai Clarence Kwan, Teegan Reina Lim, Rajneesh Kumar, and Thinesh Lee Krishnamoorthy.
• Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.
• Singap Med J. 2019 Oct 1; 60 (10): 545-549.

AbstractThe increasing number of patients on the Singapore national liver transplant waiting list and the lack of donor livers have necessitated a review of the limited use of marginal donor liver grafts. Some grafts are of good quality but are considered marginal due to positive donor antibody to hepatitis B virus core protein serology, and negative hepatitis B surface antigen (HBsAg) and hepatitis B DNA. The fear is of viral reactivation during periods of intense immunosuppression. This is made possible by the ability of the hepatitis B virion to reside in a dormant state within the hepatocyte nucleus despite HBsAg clearance, i.e. the occult hepatitis B infection (OBI). In truth, appropriate selection of recipients and effective post-transplantation immunoprophylaxis significantly reduce the risk of hepatitis B viral reactivation. This article explains the confusion surrounding OBI and reviews current recommendations on how to manage such donor liver grafts.Copyright: © Singapore Medical Association.

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