Hepatitis B-core Antibody Positive Donors in Liver Transplantation and Their Impact on Graft Survival: Evidence From The Liver Match Cohort Study

BACKGROUND: The appropriate allocation of grafts from HBcAb positive donors in liver transplantation is crucial; yet a consensus is still lacking. METHODS: We evaluated this issue within Liver Match; a prospective observational Italian study. Data from 1437 consecutive; first transplants performed in 2007-2009 using grafts from deceased heart beating donors were analyzed (median follow-up: 1040 days). Of these; 219 (15.2%) were HBcAb positive. Sixty-six HBcAb positive grafts were allocated to HBsAg positive and 153 to HBsAg negative recipients. RESULTS: 329 graft losses occurred (22.9%): 66 (30.1%) among 219 recipients of HBcAb positive grafts; and 263 (21.6%) among 1218 recipients of HBcAb negative grafts. Graft survival was lower in recipients of HBcAb positive compared to HBcAb negative donors; with unadjusted 3-year graft survival of 0.69 (s.e. 0.032) and 0.77 (0.013); respectively (log-rank; p=0.0047). After stratifying for recipient HBsAg status; this difference was only observed among HBsAg negative recipients (log rank; p=0.0007); 3-year graft survival being excellent (0.88; s.e. 0.020) among HBsAg positive recipients; regardless of the HBcAb donor status (log rank; p= 0.4478). Graft loss due to de novo HBV hepatitis occurred only in one patient. At Cox regression hazard ratios for graft loss were: MELD (1.30 per 10 units; p=0.0002); donor HBcAb positivity (1.56; p=0.0015); recipient HBsAg positivity (0.43; p<0.0001); portal vein thrombosis (1.99; p=0.0156); and DRI (1.41 per unit; p=0.0325). CONCLUSION: HBcAb positive donor grafts have better outcomes when transplanted into HBsAg positive than HBsAg negative recipients. These findings suggest that donor HBcAb positivity requires more stringent allocation strategies