Outcomes of hepatitis C- and hepatitis B core antibody-positive grafts in orthotopic liver transplantation.
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.
Saab
Sammy
S
Department of Medicine, Division of Digestive Diseases, Dumont-UCLA Liver Transplant Center, University of California Los Angeles, 90095, USA. Ssaab@mednet.ucla.edu
Chang
Albert J
AJ
Comulada
Scott
S
Geevarghese
Sunil K
SK
Anselmo
R Dean M
RD
Durazo
Francisco
F
Han
Steven
S
Farmer
Douglas G
DG
Yersiz
Hasan
H
Goldstein
Leonard I
LI
Ghobrial
R Mark
RM
Busuttil
Ronald W
RW
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005838:Genotype; D006085:Graft Survival; D016174:Hepacivirus / Q000235:genetics; D006510:Hepatitis B Antibodies / Q000097:blood*; D006512:Hepatitis B Core Antigens / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000401:mortality / Q000517:prevention & control / Q000601:surgery*; D018937:Hepatitis C Antibodies / Q000097:blood*; D018936:Hepatitis C Antigens / Q000276:immunology; D019698:Hepatitis C, Chronic / Q000401:mortality / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D016016:Proportional Hazards Models; D012008:Recurrence; D016019:Survival Analysis; D009927:Tissue and Organ Procurement / Q000592:standards*
D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D018937:Hepatitis C Antibodies; D018936:Hepatitis C Antigens