Use of Hepatitis B surface antigen–positive grafts in liver transplantation: A matched analysis of the US national database

Liver Transplantation

Accepted Article (Accepted, unedited articles published online and citable. The final edited and typeset version of record will appear in future.)

Original Article

Zhiwei Li^†, Zhenhua Hu^†, Jie Xiang, Jie Zhou, Sheng Yan, Jian Wu, Lin Zhou, Shusen Zheng^*

DOI: 10.1002/lt.23774

©2013. American Association for the Study of Liver Diseases

Keywords: Liver transplant; HbsAg; HBIG; Registry; Marginal donor

Abstract

The scarcity of available donor organs is the key challenge in orthotopic liver transplantation. A viable way to expand the donor pool is the use of liver grafts from hepatitis B virus surface antigen–positive donors. The present study used the US Scientific Registry of Transplant Recipients database (1987–2010), and 78 patients undergoing OLTs with HBsAg-positive grafts were each matched for urgent status, gender of donor and recipient, age of donor and recipient, transplant date, Model for End-Stage Liver Disease score, and warm ischemia time with four patients receiving HBsAg-negative grafts. Overall graft and patient survival was similar in recipients with HBsAg-positive grafts and matched controls (five-year survival: 66% versus 64%, P = 0.954 and 71% versus 71%, P = 0.870, respectively). Cox proportional regression analysis adjusting for other variables showed no impact of donor HBsAg status on graft or patient survival. The use of hepatitis B immunoglobulin was independently associated with better post-transplant graft and patient survival in recipients with HBsAg-positive grafts (HR = 0.23, 95% CI = 0.06–0.81 and HR = 0.16, 95% CI = 0.04–0.75, respectively). In conclusion, the use of HBsAg-positive liver grafts did not reduce post-transplant graft or patient survival. Moreover, matching these donors to recipients treated with HBIG may improve safety. Liver Transpl , 2013. © 2013 AASLD.

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