Published online Dec 28, 2018. doi: 10.3748/wjg.v24.i48.5525
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
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.
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.
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.
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.
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.
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.
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.