Invited Review Early View

Using Hepatitis B Surface Antigen–Positive Donors in Liver Transplantation: Outcomes, Prophylaxis, and Monitoring with a Focus on Hepatitis B Virus–Naive Recipients

Publish Date: May 13, 2026
Ali Emre Bardak ORCID Aafeen Mujeeb ORCID Ayse Eylul Donmez ORCID Nazli Begum Ozturk ORCID Eda Yildiz ORCID Hemeesh Tandel ORCID Merih Deniz Toruner ORCID Merve Gurakar ORCID Behnam Saberi ORCID Nilay Danis ORCID Ahmet Gurakar ORCID
Full Text PDF
DOI

Published In

Turkish Journal of Gastroenterology

History

Published Online: May 13, 2026

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Ali Emre Bardak ORCID
Department of Internal Medicine, Boston Medical Center, Boston, MA, USA
Aafeen Mujeeb ORCID
Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Ayse Eylul Donmez ORCID
Children’s Hospital, University of Illinois, Chicago, USA
Nazli Begum Ozturk ORCID
Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, MO, USA
Eda Yildiz ORCID
Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Hemeesh Tandel ORCID
Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Merih Deniz Toruner ORCID
Warren Alpert Medical School of Brown University, RI, USA
Merve Gurakar ORCID
Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Behnam Saberi ORCID
Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
Nilay Danis ORCID
Division of Gastroenterology, Department of Internal Medicine, Dokuz Eylül University, İzmir, Türkiye
Ahmet Gurakar ORCID
Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Bardak, A. E., Mujeeb, A., Donmez, A. E., Ozturk, N. B., Yildiz, E., Tandel, H., … Gurakar, A. (2026). Using Hepatitis B Surface Antigen–Positive Donors in Liver Transplantation: Outcomes, Prophylaxis, and Monitoring with a Focus on Hepatitis B Virus–Naive Recipients. Turkish Journal of Gastroenterology. https://doi.org/10.5152/tjg.2026.26018
Endnote/Zotero/Mendeley (RIS) BibTeX
Full Text Full Text PDF

Abstract

Liver transplantation (LT) remains the only definitive treatment for end-stage liver disease and selected hepatic malignancies. However, persistent organ shortages continue to drive high waitlist mortality worldwide. Hepatitis B virus (HBV)-positive donors, including hepatitis B surface antigen (HBsAg)-positive and anti-hepatitis B core antibody–positive (HBsAg negative) donors, represent an increasingly important but historically underused resource. The introduction of high-barrier nucleos(t)ide analogs, the selective use of hepatitis B immunoglobulin, and pre- and posttransplant vaccination have markedly reduced viral transmission, enabling safe transplantation in both HBV-immune and selected HBV-naive recipients. Regional guidelines and consensus statements, including those from the American Society of Transplantation, European Association for the Study of the Liver, American Association for the Study of Liver Diseases, and Asian Pacific Association for the Study of the Liver, support individualized, risk-directed prophylaxis and posttransplant surveillance. Ethical considerations, particularly informed consent and risk–benefit discussions in the setting of organ scarcity, remain central to clinical decision-making. Large cohort studies demonstrate comparable graft and patient survival with HBV-negative grafts, along with economic advantages and expansion of the donor pool. However, evidence in HBV-naive recipients remains limited, with most data derived from immune or previously infected recipients, highlighting the need for careful patient selection and robust prophylaxis. Available evidence on the use of HBsAg-positive donors in HBV-naive recipients is obtained predominantly from cadaveric donor transplantation, as experience with HBsAg-positive living donors remains limited. This narrative review summarizes current evidence on the use of HBsAg-positive grafts in LT, with a focus on HBV-naive recipients, based predominantly on cadaveric donor experience.

Cite this article as: Bardak AE, Mujeeb A, Donmez AE, et al. Using hepatitis B surface antigen–positive donors in liver transplantation: Outcomes, prophylaxis, and monitoring with a focus on hepatitis B virus–naive recipients. Turk J Gastroenterol. Published online May 13, 2026. doi: 10.5152/tjg.2026.26018.

Most read articles by the same author(s)

1 2 > >> 
Article Info
Published In
Journal Turkish Journal of Gastroenterology
DOI 10.5152/tjg.2026.26018
History
Published Online May 13, 2026
License
Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Affiliations
Ali Emre Bardak ORCID
Department of Internal Medicine, Boston Medical Center, Boston, MA, USA
Aafeen Mujeeb ORCID
Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Ayse Eylul Donmez ORCID
Children’s Hospital, University of Illinois, Chicago, USA
Nazli Begum Ozturk ORCID
Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, MO, USA
Eda Yildiz ORCID
Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Hemeesh Tandel ORCID
Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Merih Deniz Toruner ORCID
Warren Alpert Medical School of Brown University, RI, USA
Merve Gurakar ORCID
Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Behnam Saberi ORCID
Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
Nilay Danis ORCID
Division of Gastroenterology, Department of Internal Medicine, Dokuz Eylül University, İzmir, Türkiye
Ahmet Gurakar ORCID
Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Cite this Article
Bardak, A. E., Mujeeb, A., Donmez, A. E., Ozturk, N. B., Yildiz, E., Tandel, H., … Gurakar, A. (2026). Using Hepatitis B Surface Antigen–Positive Donors in Liver Transplantation: Outcomes, Prophylaxis, and Monitoring with a Focus on Hepatitis B Virus–Naive Recipients. Turkish Journal of Gastroenterology. https://doi.org/10.5152/tjg.2026.26018
Download Citation
Endnote/Zotero/Mendeley (RIS) BibTeX
Outlines