Outcomes of hepatitis C- and hepatitis B core antibody-positive grafts in orthotopic liver transplantation

Liver Transpl. 2003 Oct;9(10):1053-61. doi: 10.1053/jlts.2003.50208.

Abstract

The use of hepatitis B core antibody (HBcAb)- and hepatitis C virus antibody (HCV+) liver grafts for transplantation in selected populations has not affected patient and graft survival. We reexamined the clinical outcomes of using these HBcAb+ and HCV+ grafts at our institution, in addition to studying recipients of combined HBcAb+/HCV+ grafts. We identified 377 patients who underwent transplantation for either hepatitis B and/or hepatitis C, or received both HBcAb+ and HCV+ grafts. Patient and graft survival at 5 years posttransplantation was 73% and 71%, respectively, in the HBcAb+ grafts compared with 81% and 75% in the HBcAb- grafts (P =.65; P =.94). For HCV+ grafts, patient and graft survival at 5 years posttransplantation was 89% and 73%, respectively, compared with 69% and 59% in the HCV- grafts; (P =.22; P =.77). The 5-year patient and graft survival rate in those who received combined HBcAb+/HCV+ grafts was 74% and 69%, respectively, and there was no statistical difference compared with the HBcAb+ and HCV+ grafts (P =.76; P =.90). The 5-year patient and graft survival rate in patients who received dual HBV prophylaxis with hepatitis B immunoglobulin (HBIg) and lamivudine was 88% and 84%, respectively, which was significantly higher than for patients who received single prophylaxis or no prophylaxis (P <.01; P =.02). Our study supports previous observations that patient and graft survival is not affected with the use of HBcAb+ and HCV+ grafts, and that dual prophylaxis with HBIg and lamivudine offers substantial survival benefits. Furthermore, the use of combined HBcAb+/HCV+ grafts did not impact patient or graft survival. This provides a potential new pool of donor livers that can be used for transplantation in select patients.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Female
  • Genotype
  • Graft Survival
  • Hepacivirus / genetics
  • Hepatitis B Antibodies / blood*
  • Hepatitis B Core Antigens / immunology
  • Hepatitis B, Chronic / mortality
  • Hepatitis B, Chronic / prevention & control
  • Hepatitis B, Chronic / surgery*
  • Hepatitis C Antibodies / blood*
  • Hepatitis C Antigens / immunology
  • Hepatitis C, Chronic / mortality
  • Hepatitis C, Chronic / surgery*
  • Humans
  • Liver Transplantation / mortality*
  • Male
  • Middle Aged
  • Patient Selection
  • Proportional Hazards Models
  • Recurrence
  • Survival Analysis
  • Tissue and Organ Procurement / standards*

Substances

  • Hepatitis B Antibodies
  • Hepatitis B Core Antigens
  • Hepatitis C Antibodies
  • Hepatitis C Antigens