Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2018; 24(48): 5525-5536
Published online Dec 28, 2018. doi: 10.3748/wjg.v24.i48.5525
Safety of hepatitis B virus core antibody-positive grafts in liver transplantation: A single-center experience in China
Ming Lei, Lu-Nan Yan, Jia-Yin Yang, Tian-Fu Wen, Bo Li, Wen-Tao Wang, Hong Wu, Ming-Qing Xu, Zhe-Yu Chen, Yong-Gang Wei
Ming Lei, Lu-Nan Yan, Jia-Yin Yang, Tian-Fu Wen, Bo Li, Wen-Tao Wang, Hong Wu, Ming-Qing Xu, Zhe-Yu Chen, Yong-Gang Wei, Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Lei M and Yan LN conceived and designed the study; Lei M and Yang JY analyzed the data; Lei M and Yan LN drafted the manuscript; Yan LN and Yang JY critically revised the manuscript; Yang JY, Wen TF, Li B, Wang WT, Wu H, Xu MQ, Chen ZY and Wei YG acquired the data and provided technical support; all authors have read and approved the final version to be published.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the West China Hospital of Sichuan University.
Informed consent statement: Written informed consent was obtained from all participants.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Lu-Nan Yan, MD, Professor, Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, 37 Guoxuexiang, Chengdu 610041, Sichuan Province, China.
Telephone: +86-28-85422867 Fax: +86-28-85422867
Received: November 9, 2018
Peer-review started: November 12, 2018
First decision: December 7, 2018
Revised: December 8, 2018
Accepted: December 13, 2018
Article in press: December 13, 2018
Published online: December 28, 2018
Research background

Given the shortage of suitable liver grafts for liver transplantation, proper use of hepatitis B core antibody-positive livers might be a possible way to enlarge the donor pool and to save patients with end-stage liver diseases. However, the safety of hepatitis B virus core antibody positive (HBcAb+) donors has been controversial. Initial studies were mainly conducted overseas with relatively small numbers of HBcAb+ liver recipients, and there are few relevant reports in the population of mainland China.

Research motivation

We performed this study to evaluate the safety of HBcAb+ liver graft recipients in a Chinese population and to investigate the feasibility of wide utilization of such liver grafts.

Research objectives

The objectives of our study were: (1) to evaluate the long-term survival of HBcAb+ liver graft recipients; and (2) to investigate the post-transplant hepatitis B virus infection rates of HBcAb+ liver graft recipients and to elucidate possible risk factors.

Research methods

We conducted a retrospective study, enrolling 1071 patients who consecutively underwent liver transplantation from 2005 to 2016 at West China Hospital Liver Transplantation Center. Given the imbalance in several baseline variables, propensity score matching was used, and the outcomes of all recipients were reviewed in this study.

Research results

Our results revealed that the 1-, 3- and 5-year survival rates in patients and grafts between the HBcAb+ and HBcAb- recipients showed no difference (P = 0.16 and 0.19, respectively), and receiving HBcAb+ liver grafts was not a significant risk factor for long-term survival. Further studies illustrated that post-transplant major complication rates and liver function recovery after surgery were also similar. These findings were consistent in both HBsAg+ and HBsAg- patients. Newly diagnosed HBV infection had a relatively higher incidence in HBsAg- patients with HBcAb+ liver grafts (13.23%), in which HBV-naïve recipients suffered most (31.82%), whereas it did not affect patient and graft survival (P = 0.50 and 0.49, respectively). Recipients with high anti-HBs titers (more than 100 IU/L) before transplantation and antiviral prophylaxis with nucleos(t)ide antiviral agents post-operation had lower de novo HBV infection risks.

Research conclusions

HBcAb+ grafts did not increase the post-transplant mortality, nor did they affect post-transplant major complication rates and liver function recovery. HBV-naïve recipients suffered post-transplantation de novo HBV infection more often, and sufficient anti-HBs titers in recipients might be a protective factor. Combined with proper postoperative antiviral prophylaxis, such as nucleos(t)ide antiviral agents, utilization of HBcAb+ grafts is rational and feasible.

Research perspectives

Further multicenter studies are needed to investigate more interval time groups with a large sample size on the outcome of HBcAb+ graft recipients. The findings of this study should spur more investigators to evaluate the ideal postoperative antiviral therapy, which may involve active immunization prophylaxis.