In a retrospective analysis of 456 lung transplant recipients, Hartwig et al. [20] assessed the risk of viral transmission and safety in patients who received hepatitis B core antibody (HbcAb+) and hepatitis C antibody (HCV Ab+) pulmonary allografts. Twenty-nine patients (HB group) received HbcAb+ allografts and 3 (HC group) received HCV Ab+ allografts. The survival rate at 1 year was 83% in the HB group when compared to 82% who received non-HB organs. None of the patients in the HB group developed clinical viral disease due to viral hepatitis, whereas one died of liver failure in the HC group during follow-up. The authors conclude that the use of HbcAb+ pulmonary allografts in recipients with prior immunisation seems to be safe and effective strategy to overcome organ shortage. Similarly, analysis of 333 recipients of HbcAb+ donor organs from UNOS/OPTN registries had shown that donor HbcAb+ status did not impact 1- or 5-year survival after transplant. Authors conclude that lung and heart-lung allografts from HbcAb+ donors may be safely used and this would increase the number of transplants performed without compromising recipient outcomes [21]. Although the above studies show encouraging results, they have several limitations including the retrospective nature, small cohort size, and short duration of follow-up. 5.3. Liver Transplantation Liver disease caused by HBV and HCV infection remains the main indication for liver transplantation in developed countries. Recurrence of HBV and HCV infection can pose a major problem after transplant and can lead to poor patient and graft survival. In a retrospective analysis of the UNOS registry, Singal et al. [22] analysed the frequency and outcomes of liver transplantation based on etiology of liver transplant. Between 1994 and 2009, 54,687 adult liver transplants were performed in the United States. Of these, 15,147 liver transplantation processes were done for HCV+ infection, 1816 were for HBV+, 6066 were for HCV+ and alcohol, and the rest were for other conditions causing chronic liver disease. The five-year graft and patient survival was 80�C85% in HBV+ patients, whereas the HCV+, HCV+, and alcohol group had the worst outcome (hazard ratio, 1.5�C2.4). This has been attributed to HCV recurrence with rapid progression of fibrosis resulting in cirrhosis. Interestingly, Reddy and Everson [23] reported on a 54-year-old man, who developed HCV recurrence after liver transplantation. Treatment with pegylated interferon and ribavirin resulted in rapid virological response but relapsed after 48 weeks of treatment. Patient was subsequently given a 48-week triple therapy regime when the new protease inhibitors (boceprevir) became available. HCV RNA levels were undetectable 12 weeks from the start of the therapy and the levels remained negative 12 weeks even after cessation of therapy.