Can receiving a liver transplant from a donor with Hepatitis B Virus cause infection?

Yes, receiving a liver transplant from a donor with active hepatitis B virus (HBV) can cause infection in the recipient. However, the risk is relatively low — about 4% in kidney transplants from active HBV donors, and likely similar for liver transplants. The risk can be further reduced with antiviral medications and vaccination. Doctors carefully screen donors and use preventive treatments to protect recipients.

What the research says

A 2024 meta-analysis of kidney transplants from donors with active HBV (positive HBsAg or HBV DNA) found a pooled transmission rate of 4.0% (95% CI, 1.8%-8.3%) among 600 HBsAg-negative recipients ⁷. Most transmissions were transient low-level viremia, and many recipients had protective antibodies or received antiviral prophylaxis ⁷. For liver transplants specifically, occult HBV infection (OBI) — where HBV DNA is present without detectable surface antigen — can also be transmitted through organ transplantation, including liver transplantation ⁹. Without prophylaxis, liver transplantation for chronic hepatitis B has high rates of viral recurrence and poor survival; however, with modern antiviral drugs and hepatitis B immunoglobulins, 5-year survival is about 85% ¹⁰. Unexpected donor-derived HBV infection is rare but can occur even when donors test negative for standard HBV markers, especially if the donor had recent injection drug use ¹¹.

What to ask your doctor

• What is the donor's hepatitis B status, and what specific tests were done (HBsAg, anti-HBc, HBV DNA)?
• Will I receive antiviral medication or hepatitis B immunoglobulin after transplant to prevent infection?
• How often will my HBV DNA and HBsAg be checked after transplant?
• Should I be vaccinated against hepatitis B before or after transplant?
• What are the signs of a new HBV infection, and when should I seek medical attention?