Safety of hepatitis B virus core antibody-positive grafts in liver transplantation: A single-center experience in China

Table 1 Baseline clinical data between hepatitis B virus core antibody positive and hepatitis B virus core antibody negative liver graft recipients

Factor	Before propensity matching			After propensity matching
	HBcAb+ (n = 230)	HBcAb- (n = 841)	P value	HBcAb+ (n = 210)	HBcAb- (n = 210)	P value
Baseline characteristic
Gender (male)	77.4% (178)	80.10% (674)	0.36	80.5% (169)	79.5% (167)	0.90
Age (yr)	41.03 ± 15.58	42.04 ± 15.19	0.63	40.67 ± 16.57	40.55 ± 15.47	0.94
BMI	22.1 (19.7-24.2)	22.0 (19.8-24.4)	0.54	22.4 (19.7-24.4)	22.2 (19.7-24.2)	0.8
MELD	13.0 (9.0-21.0)	13.0 (9.0-20.0)	0.62	14.5 (10.0-20.8)	13.0 (9.0-20.0)	0.25
CTP	9.0 (7.0-11.0)	8.0 (7.0-10.0)	< 0.01	9.0 (7.0-11.0)	9.0 (7.0-11.0)	0.14
Creatinine (µmol/L)	67.0 (53.1-81.9)	71.9 (59.3-85.3)	< 0.01	68.4 (55.9-82.6)	67.5 (53.6-82.4)	0.36
Total bilirubin (µmol/L)	43.2 (18.8-198.3)	37.8 (18.9-139.9)	0.31	51.2 (22.8-201.9)	40.2 (18.6-195.0)	0.20
Albumin (g/L)	35.4 (30.9-40.5)	34.6 (30.1-40.1)	0.11	33.8 (30.1-40.1)	35.4 (31.1-41.3)	0.06
HBV-positive	64.78% (149)	77.28% (650)	< 0.01	62.9% (132)	69.0% (145)	0.18
HCV-positive	1.3% (3)	7.4% (62)	< 0.01	0.95% (2)	3.33% (7)	0.18
Etiology
Liver cancer	48.26% (111)	46.13% (388)	0.57	43.3% (91)	49.5% (104)	0.20
Acute liver failure	11.30% (26)	4.99% (42)	< 0.01	8.57% (18)	11.4% (24)	0.32
Cirrhosis
Biliary	9.13% (21)	7.84% (66)	0.53	8.57% (18)	9.05% (19)	0.86
HBV related	49.13% (113)	55.41% (466)	0.09	56.19% (118)	54.76% (15)	0.76
HCV related	0.86% (2)	1.90% (16)	0.28	0.95% (2)	2.38% (5)	0.45
Alcoholic	2.17% (5)	3.21% (27)	0.41	1.90% (4)	0.95% (2)	0.69
Autoimmune	1.74% (4)	1.07% (9)	0.41	0.95% (2)	0.95% (2)	1.00
Donor
Gender (male)	74.35% (171)	79.30% (666)	0.12	61.4% (129)	61.9% (130)	0.92
Age	41.28 ± 13.01	33.66 ± 10.16	< 0.01	39.08 ± 10.59	40.82 ± 12.36	0.12
BMI	22.7 (20.8-24.6)	22.2 (20.8-23.9)	0.06	22.8 (21.4-24.8)	22.6 (20.8-24.5)	0.37
Serum Na+ (mmol/L)	143.0 (140.1-153.6)	139.9 (136.2-142.7)	< 0.01	141.6 (138.5-143.9)	141.9 (140.0-153.5)	0.23
Creatinine (µmol/L)	73.1 (54.5-98.5)	74.6 (62.8-84.6)	< 0.01	75.3 (63.0-88.5)	74.4 (54.0-95.6)	0.39
Total bilirubin (µmol/L)	13.8 (9.4-18.9)	15.1 (10.2-23.3)	0.05	14.9 (10.1-21.7)	13.8 (9.4-18.7)	0.25
Albumin (g/L)	40.3 (32.6-45.3)	41.9 (36.2-46.6)	0.06	42.1 (36.2-46.7)	41.8 (34.9-46.0)	0.12
ALT (IU/L)	23.0 (16.0-45.0)	28.0 (16.0-47.0)	0.32	27.0 (17.8-46.2)	26.0 (16.0-43.0)	0.10
AST (IU/L)	27.0 (20.8-42.0)	26.0 (18.0-39.0)	0.15	27.0 (19.0-39.8)	27.5 (20.0-47.0)	0.12
Cold ischemic time (h)	5.0 (3.2-7.8)	6.0 (5.0-10.0)	0.05	5.5 (4.0-8.0)	5.5 (3.0-7.0)	0.11
Warm ischemic time (min)	6.0 (3.0-9.0)	4.5 (2.0-6.5)	0.05	6.0 (3.0-10.0)	5.0 (3.0-7.0)	0.08

Data are shown as the mean ± SD or medians with 25^th-75^th interquartile ranges when presenting significant differences from the normal distribution. For continuous variables, either the Mann-Whitney U-test or Student’s-t test was performed, and the differences between rates were tested by Chi square test or Fisher exact test, if appropriate. CTP: Child-Pugh score; ALT: Glutamic-pyruvic transaminase; AST: Glutamic oxaloacetic transaminase; MELD: Model for end-stage liver disease.

Table 2 Multivariable Cox analysis for patient and graft survival in the original cohort (n = 1071)

	Patient survival				Graft survival
Equation variable	P value	HR	95%CI		P value	HR	95%CI
Recipient
BMI	0.001	1.006	1.002	1.010	0.001	1.007	1.002	1.011
MELD	0.942	1.002	0.948	1.059	0.912	1.003	0.949	1.059
CTP	0.429	1.049	0.835	1.263	0.398	1.046	0.834	1.258
HBsAb (negative vs positive)	0.208	1.058	0.768	1.347	0.258	1.027	0.739	1.374
Operation
Anhepatic phase (min)	0.271	1.003	0.997	1.01	0.169	1.004	0.998	1.011
RBC transfusion (U)	0.018	1.055	1.009	1.104	0.021	1.052	1.006	1.103
After operation
Mechanical ventilation (h)	0.002	1.003	1.001	1.006	0.004	1.004	1.001	1.006
Postoperative HBV infection (negative vs positive)	0.502	0.597	0.132	2.695	0.490	0.527	0.118	2.340
Donor
Age	0.215	1.015	0.991	1.042	0.155	1.018	0.992	1.045
AST (IU/L)	0.65	1.002	0.993	1.011	0.563	1.002	0.994	1.011
Na (mmol/L)	0.243	1.016	0.988	1.045	0.408	1.011	0.983	1.041
Anti HBc-positive (negative vs positive)	0.675	1.175	0.551	2.505	0.982	1.008	0.480	2.118

HR: Hazard ratio; CTP score: Child-Pugh score; WIT: Warm ischemic time Na: Donor’s serum Na⁺ concentration.

Table 3 Multivariable Cox analysis and propensity score-matched analysis of patient survival

Group	No. of patients	HR (95%CI)	P value
Entire cohort, multivariable-adjusted (n = 1071)
HbcAb-positive grafts	230	1.18 (0.55,2.51)	0.68
HbcAb-negative grafts	841	Reference
Entire cohort, propensity score-matched (n = 210 pairs)
HbcAb-positive grafts	210	1.21 (0.73,2.03)	0.45
HbcAb-negative grafts	210	Reference
HBsAg-positive cohort, multivariable-adjusted (n = 799)
HbcAb-positive grafts	149	1.07 (0.98,1.17)	0.12
HbcAb-negative grafts	650	Reference
HBsAg-positive cohort, propensity score-matched (n = 132 pairs)
HbcAb-positive grafts	132	1.06 (0.93,1.20)	0.37
HbcAb-negative grafts	132	Reference
HBsAg-negative cohort, multivariable-adjusted (n = 272)
HbcAb-positive grafts	81	1.42 (0.71,2.81)	0.32
HbcAb-negative grafts	191	Reference
HBsAg-negative cohort, propensity score-matched (n = 77 pairs)
HbcAb-positive grafts	77	1.37 (0.60,3.14)	0.45
HbcAb-negative grafts	77	Reference

Table 4 Early stage major complications after operation between hepatitis B virus core antibody positive liver graft recipients and hepatitis B virus core antibody negative liver graft recipients (within 30 d post liver transplantation) %

Major complication	Before propensity matching			After propensity matching
	Anti-HBc+ (n = 230)	Anti-HBc- (n = 841)	P value	Anti-HBc+ (n = 210)	Anti-HBc- (n = 210)	P value
Primary non-function	0.43 (1/230)	0.24 (2/841)	0.52	0	0	1.00
Biliary complications	0.87 (2/230)	1.30 (11/841)	0.75	0.47 (1/210)	0.47 (1/210)	1.00
Hepatic artery stenosis/embolism	2.61 (6/230)	1.54 (13/841)	0.26	2.38 (5/210)	1.43 (3/210)	0.72
Portal vein stenosis/embolism	3.91 (9/230)	2.49 (21/841)	0.25	3.33 (7/210)	0.95 (2/210)	0.17
Outflow tract stenosis/embolism	0.87 (2/230)	0.36 (3/841)	0.29	0.47 (1/210)	0.47 (1/210)	1.00
Bacterial infection	21.30 (49/230)	20.33 (171/841)	0.75	8.10 (17/210)	7.62 (16/210)	0.85
Intra-abdominal hemorrhage	7.39 (17/230)	5.35 (45/841)	0.24	5.24 (11/210)	2.38 (5/210)	0.20
Pleural effusion	10.86 (25/230)	15.21 (128/841)	0.09	5.71 (12/210)	3.33 (7/210)	0.24
Celiac effusion	11.74 (27/230)	14.86 (125/841)	0.23	7.62 (16/210)	8.10 (17/210)	0.85
Pneumonedema	0.43 (1/230)	0.36 (3/841)	> 0.9	0.47 (1/210)	0.47 (1/210)	1.00

Differences between rates were tested by Chi-square test or Fisher exact test, if appropriate.

Table 5 Later period major complications after operation between hepatitis B virus core antibody positive liver graft recipients and hepatitis B virus core antibody negative liver graft recipients (beyond 30 d post liver transplantation) %

Major complication	Before propensity matching			After propensity matching
	Anti-HBc+ (n = 230)	Anti-HBc- (n = 841)	P value	Anti-HBc+ (n = 210)	Anti-HBc- (n = 210)	P value
Acute rejection	11.30 (26/230)	11.05 (93/841)	0.91	9.52 (20/210)	8.10 (17/210)	0.60
Chronic rejection	0.87 (2/230)	0.95 (8/841)	> 0.9	0.95 (2/210)	0.95 (2/210)	1.00
GVHD	0.43 (1/230)	0.59 (5/841)	> 0.9	0.47 (1/210)	0.47 (1/210)	1.00
Biliary complications	9.56 (22/230)	9.15 (77/841)	0.85	7.14 (15/210)	10.95 (23/210)	0.17
Hepatic artery stenosis/embolism	0.87 (2/230)	0.71 (6/841)	0.68	0.95 (2/210)	2.38 (5/210)	0.45
Portal vein stenosis/embolism	0.87 (2/230)	1.78 (15/841)	0.55	0.95 (2/210)	0.95 (2/210)	1.00
Outflow tract stenosis/embolism	0.43 (1/230)	0.71 (6/841)	> 0.9	0.47 (1/210)	0.47 (1/210)	1.00
Tumor recurrence	5.65 (13/230)	4.52 (38/841)	0.51	4.76 (10/210)	6.19 (13/210)	0.52
CMV infection	0.87 (2/230)	0.83 (7/841)	> 0.9	0.95 (2/210)	1.90 (4/210)	0.68
Opportunistic infection	2.17 (5/230)	1.43 (12/841)	0.38	1.43 (3/210)	2.38 (5/210)	0.72
Diabetes mellitus	7.82 (18/230)	7.97 (67/841)	0.94	7.14 (15/210)	4.76 (10/210)	0.3
Hypertension	4.78 (11/230)	3.57 (30/841)	0.39	3.33 (7/210)	2.38 (5/210)	0.77
Hyperlipemia	0.43 (1/230)	0.95 (8/841)	0.69	0.47 (1/210)	1.90 (4/210)	0.37

Differences between rates were tested by Chi square test or Fisher exact test, if appropriate. CMV: Cytomegalovirus; GVHD: Graft-vs-host disease.