Liver transplantation using hepatitis B core positive grafts with antiviral monotherapy prophylaxis

[Display omitted] •Anti-HBc positive liver grafts did not lead to inferior survival after liver transplantation.•Donor anti-HBc status did not impact on graft and patient survival, or HCC recurrence.•De novo HBV infection was extremely rare with entecavir monoprophylaxis. The impact of hepatitis B c...

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Published in:Journal of hepatology 2019-06, Vol.70 (6), p.1114-1122
Main Authors: Wong, Tiffany Cho-Lam, Fung, James Yan-Yue, Cui, Tracy Yu-Shi, Lam, Allan Hoi-Kin, Dai, Jeff Wing-Chiu, Chan, Albert Chi-Yan, Cheung, Tan-To, Chok, Kenneth Siu-Ho, Ng, Kelvin Kwok-Chai, Lo, Chung-Mau
Format: Article
Language:English
Subjects:
De novo HBV
De novo hepatocellular carcinoma
Donors
Entecavir
Extended criteria organ
Hepatitis
Hepatitis B
Hepatitis B surface antigen
Hepatocellular carcinoma
Lamivudine
Liver transplantation
Long-term survival
Patients
Prophylaxis
Survival
Transplants & implants
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Summary:[Display omitted] •Anti-HBc positive liver grafts did not lead to inferior survival after liver transplantation.•Donor anti-HBc status did not impact on graft and patient survival, or HCC recurrence.•De novo HBV infection was extremely rare with entecavir monoprophylaxis. The impact of hepatitis B core antibody (anti-HBc) positive liver grafts on survival and the risk of de novo hepatitis B virus (HBV) infection after liver transplantation (LT) remain controversial. Therefore, we aimed to analyze this risk and the associated outcomes in a large cohort of patients. This was a retrospective study that included all adults who underwent LT at Queen Mary Hospital, Hong Kong, between 2000 and 2015. Data were retrieved from a prospectively collected database. Antiviral monotherapy prophylaxis was given for patients receiving grafts from anti-HBc positive donors. A total of 964 LTs were performed during the study period, with 416 (43.2%) anti-HBc positive and 548 (56.8%) anti-HBc negative donors. The median follow-up time was 7.8 years. Perioperative outcomes (hospital mortality, complications, primary nonfunction and delayed graft function) were similar between the 2 groups. The 1-, 5- and 10-year graft survival rates were comparable in anti-HBc positive (93.3%, 85.3% and 76.8%) and anti-HBc negative groups (92.5%, 82.9% and 78.4%, p = 0.944). The 1-, 5- and 10-year patient survival rates in anti-HBc positive group were 94.2%, 87% and 79% and were similar to the anti-HBc negative group (93.5%, 84% and 79.7%, p = 0.712). One-hundred and eight HBsAg negative recipients received anti-HBc positive grafts, of whom 64 received lamivudine and 44 entecavir monotherapy prophylaxis. The risk of de novo HBV was 3/108 (2.8%) and all occurred in the lamivudine era. There were 659 HBsAg-positive patients and 308 (46.7%) received anti-HBc positive grafts. The risk of HBV recurrence was similar between the 2 groups. Donor anti-HBc status did not impact on long-term patient and graft survival, or the risk of hepatocellular carcinoma recurrence after LT. De novo HBV was exceedingly rare especially with entecavir prophylaxis. Anti-HBc positive grafts did not impact on perioperative and long-term outcomes after transplant. The risk of de novo hepatitis B infection after liver transplantation was rare when using hepatitis B core positive liver grafts with entecavir monotherapy prophylaxis. Hepatitis B core antibody status did not impact on perioperative and long-term outcomes after l
ISSN:0168-8278
1600-0641
DOI:10.1016/j.jhep.2019.03.003