The use of hepatitis B core antibody positive donors for liver transplantation does not lead to inferior survival

Abstract

INTRODUCTION: It is still controversial whether the use of hepatitis B core antibody (HBcAb) positive graft would lead to an inferior survival after liver transplantation (LT). Consensus is lacking regarding the optimal regimen of anti-viral prophylaxis in these patients and the reported risk of de novo hepatitis B (HBV) infection ranged from 0-14%. It was suggested that such risk was higher especially when HBcAb positive grafts were transplanted to non-HBV recipients. Our study aims to evaluate the long-term outcomes and risk of de novo HBV in using HBcAb positive grafts. METHOD: We evaluated all patients who were transplanted in our center from 1996 to 2015. All data was retrieved from a prospectively collected database. RESULTS: There were 1004 adult LT and 438 grafts (43/6%) were from HBcAb positive donors and 326 (74.4%)of these grafts were transplanted to HBV recipients while 112 (25.6%) were transplanted to non-HBV recipients. All recipients received oral antiviral prophylaxis only and had no hepatitis B immunoglobin (HBIG). Table 1 showed the clinical characteristics of donors and recipients as related to HBcAb status. Figure 1 showed the use of HBcAb positive grafts to HBV and non-HBV recipients. In fact the long-term patient and graft survival at 10 years are >80% for both group. The use of HBcAb positive graft in patients with and without hepatocellular carcinoma did not influence long-term graft and patient survival either. In fact, there was no difference in outcomes when HBcAb positive grafts were used in living donor vs. deceased donor LT; recipient MELD <30 vs. ≥30 and MELD <45 vs. ≥45. Among the 112 non-HBV patients who received a liver graft from HBcAb positive donors, only 1/112 (0.9%) developed de novo HBV. HBV DNA was 179.3 copies/ml at time of HBV recurrence and liver biopsy showed graft fibrosis and had graft failure. CONCLUSION: Our study has demonstrated the outcomes of HBcAb positive grafts in LT were excellent with minimal risk of de novo HBV. The use of oral antiviral therapy alone is adequate to prevent de novo HBV. The use of HBcAb positive grafts in non-HBV recipients is also safe.