Utilization of hepatitis B surface antigen-positive donors in liver transplantation for recipients with hepatocellular carcinoma: a retrospective and propensity score matching analysis

Zhitao Chen; Yihao Ma; Yuqi Dong; Chuanbao Chen; Hanyu Wang; Tielong Wang; Jia Yu; Xitao Hong; Maogen Chen; Xiaoshun He; Weiqiang Ju

doi:10.7717/peerj.15620

Utilization of hepatitis B surface antigen-positive donors in liver transplantation for recipients with hepatocellular carcinoma: a retrospective and propensity score matching analysis

PeerJ. 2023 Jul 26:11:e15620. doi: 10.7717/peerj.15620. eCollection 2023.

Authors

Zhitao Chen^#^{1

2}, Yihao Ma^#^{1

2}, Yuqi Dong^{1

2}, Chuanbao Chen^{1

2}, Hanyu Wang^{1

2}, Tielong Wang^{1

2}, Jia Yu^{1

2}, Xitao Hong^{1

2}, Maogen Chen^{1

2}, Xiaoshun He^{1

2}, Weiqiang Ju^{1

2}

Affiliations

¹ Organ Transplant Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Grangdong, People's Republic of China.
² Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, Guangdong, People's Republic of China.

^# Contributed equally.

Abstract

Introduction: The use of extended criteria donor (ECD) grafts such as donor with infection of hepatitis B virus (HBV) is a potential solution for organ shortage. In this study, we aimed to evaluate the safety and long-term survival of utilization of hepatitis B surface antigen-positive (HBsAg+) donor livers in HCC patients using propensity score matching (PSM) analysis.

Methods: Forty-eight donors with HBsAg-positive and 279 donors with HBsAg-negative were transplanted and enrolled in this study. PSM analysis were used to eliminate selection bias. Perioperative data and survival were collected and analyzed.

Results: PSM generated 44 patient pairs. When comparing intra- and post-operative data, no significant difference was found between groups (P > 0.05). Patients with a HBsAg-positive donor had significantly worse progression-free survival (1-year: 65.9% vs. 90.9%; 3-year: 18.1% vs. 70.4%, P = 0.0060) and overall survival (1-year: 84.1% and 95.4%; 3-year: 27.2% vs. 79.5%, P = 0.0039). In multivariate analysis, donor HBsAg-positivity was an independent risk factor for survival and occurrence (P = 0.005 and 0.025, respectively).

Conclusion: In conclusion, with adequate antiviral prophylaxis and treatment, utilization of HBsAg positive liver grafts did not increase the incidence of early-stage complications. However, patient with an HBsAg-positive graft had poorer progression-free survival and overall survival.

Keywords: Hepatitis B antigen-positive donor; Hepatocellular carcinoma; Liver transplantation; Overall survival; Progression-free survival; Propensity score matching.

Grants and funding

This work was funded by the National Natural Science Foundation of China (grand number: 81401324 and 81770410), the Science and Technology Planning Project of Guangdong Province (grand number: 2016A020215048), the Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation) (grant number: 2015B050501002), the Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology (grant number: 2013A061401007) and the Guangdong Basic and Applied Basic Research Foundation (grant number: 2020A1515011557, 2020A1515010903). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.