Liver transplantation using hepatitis B core positive grafts with antiviral monotherapy prophylaxis.
BACKGROUND & AIMS
The impact of hepatitis B core antibody (anti-HBc) positive liver grafts on survival and the risk of de novo hepatitis B virus (HBV) infection after liver transplantation (LT) remain controversial. Therefore, we aimed to analyze this risk and the associated outcomes in a large cohort of patients.


METHODS
This was a retrospective study that included all adults who underwent LT at Queen Mary Hospital, Hong Kong, between 2000 and 2015. Data were retrieved from a prospectively collected database. Antiviral monotherapy prophylaxis was given for patients receiving grafts from anti-HBc positive donors.


RESULTS
A total of 964 LTs were performed during the study period, with 416 (43.2%) anti-HBc positive and 548 (56.8%) anti-HBc negative donors. The median follow-up time was 7.8 years. Perioperative outcomes (hospital mortality, complications, primary nonfunction and delayed graft function) were similar between the 2 groups. The 1-, 5- and 10-year graft survival rates were comparable in anti-HBc positive (93.3%, 85.3% and 76.8%) and anti-HBc negative groups (92.5%, 82.9% and 78.4%, p = 0.944). The 1-, 5- and 10-year patient survival rates in anti-HBc positive group were 94.2%, 87% and 79% and were similar to the anti-HBc negative group (93.5%, 84% and 79.7%, p = 0.712). One-hundred and eight HBsAg negative recipients received anti-HBc positive grafts, of whom 64 received lamivudine and 44 entecavir monotherapy prophylaxis. The risk of de novo HBV was 3/108 (2.8%) and all occurred in the lamivudine era. There were 659 HBsAg-positive patients and 308 (46.7%) received anti-HBc positive grafts. The risk of HBV recurrence was similar between the 2 groups. Donor anti-HBc status did not impact on long-term patient and graft survival, or the risk of hepatocellular carcinoma recurrence after LT.


CONCLUSIONS
De novo HBV was exceedingly rare especially with entecavir prophylaxis. Anti-HBc positive grafts did not impact on perioperative and long-term outcomes after transplant.


LAY SUMMARY
The risk of de novo hepatitis B infection after liver transplantation was rare when using hepatitis B core positive liver grafts with entecavir monotherapy prophylaxis. Hepatitis B core antibody status did not impact on perioperative and long-term outcomes after liver transplantation. This provides support for the clinical use of hepatitis B core positive liver grafts when required.
['Wong|Tiffany Cho-Lam|TC|', 'Fung|James Yan-Yue|JY|', 'Cui|Tracy Yu-Shi|TY|', 'Lam|Allan Hoi-Kin|AH|', 'Dai|Jeff Wing-Chiu|JW|', 'Chan|Albert Chi-Yan|AC|', 'Cheung|Tan-To|TT|', 'Chok|Kenneth Siu-Ho|KS|', 'Ng|Kelvin Kwok-Chai|KK|', 'Lo|Chung-Mau|CM|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D000998:Antiviral Agents D002648:Child D002675:Child, Preschool D005260:Female D006085:Graft Survival D006509:Hepatitis B D006510:Hepatitis B Antibodies D006512:Hepatitis B Core Antigens D006801:Humans D008113:Liver Neoplasms D016031:Liver Transplantation D008297:Male D008875:Middle Aged D012189:Retrospective Studies D055815:Young Adult
Entecavir De novo HBV De novo hepatocellular carcinoma Extended criteria organ Long-term survival