Korean J Transplant.  2021 Oct;35(Supple 1):S19. 10.4285/ATW2021.OP-1256.

Safe use of hepatitis B surface antigen positive grafts in liver transplantation: a nationwide study based on Korean Organ Transplantation Registry Data

• Choi Y
• Lee KW
• Kim BW
• Kim DS
• Kim JM
• Nah YW
• Hwang S
• Lee JG
• Ryu JH
• Hong G

• KMID: 2521191
• DOI: http://doi.org/10.4285/ATW2021.OP-1256

Abstract

Background
Liver grafts from donors with chronic hepatitis B virus (HBV) infection has expanded the donor pool in HBV endemic area. Endeavor to use HBsAg (+) graft as safe alternatives were kept up for several years, and the outcome has improved by using hepatitis B virus immune globulin (HBIG) and nucleoside analogs (NA).
Methods
Among 4,265 liver transplantations (LTs) registered in the KOTRY database prospectively between April 2014 and January 2020, 39 cases (0.9%) of LTs using HBsAg (+) grafts were identified. We compared outcomes and its associating factors in LT using HBsAg (+) grafts compared to HBsAg (–) grafts (n=3,971).
Results
Twenty deceased donor LT (DDLT-HBV) and 19 living donor LT (LDLT-HBV) were performed using HBsAg (+) grafts. They maintained HBIG or NA, or both in the perioperative period. The mean end-stage liver disease (MELD) score was 15.8±9.2, and the follow-up period was 28.0±19.2 months. Six LTs were performed for patients in intensive care unit. There was no difference in the patientsʼ survival between the two groups (P=0.111). In addition, no difference between LDLT-HBV and DDLT-HBV was observed (P=0.885). Fifteen patients (38.5%) experienced HBV reactivation and HCC recurred in three patients (7.7%). Three patients underwent re-transplantation because of graft failure that was not related to HBV.
Conclusions
In the era of NA for HBV, HBsAg (+) liver graft can be used safely with expanding donor pool in HBV endemic areas.