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Abstract Details
Hepatitis B-core Antibody Positive Donors in Liver Transplantation and Their Impact on Graft Survival: Evidence From The Liver Match Cohort Study
Angelico M, Nardi A, Marianelli T, Caccamo L, Romagnoli R, Tisone G, Pinna AD, Avolio AW, Fagiuoli S, Burra P, Strazzabosco M, Costa AN. J Hepatol. 2012 Nov 27. pii: S0168-8278(12)00894-X. doi: 10.1016/j.jhep.2012.11.025. [Epub ahead of print]
Source
Liver Unit, Tor Vergata University, Rome Italy; Italian Association for the Study of the Liver (AISF), Rome, Italy. Electronic address: angelico@med.uniromab.it.
Abstract
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.