title: The use of hepatitis B core antibody-positive donor livers does not appear to have a deleterious effect on graft survival in liver transplantation for hepatitis C.
abstract: BACKGROUND
  The use of hepatitis B core antibody-positive donor livers (HBcAb(+)) has steadily increased. According to a recent multivariate analysis of United Network for Organ Sharing (UNOS) data, there was no significant increase in the risk of using these donors. The increased risk among the hepatitis C virus (HCV)-positive subgroup noted in a univariate model disappeared upon multivariate analysis. However, deeper scrutiny may show that HCV-positive recipients may be at increased risk with HBcAb(+) donor livers, as they require simultaneous treatment with two antiviral regimens there may be deleterious interactions between the two viruses. Thus, the issue of HBcAb(+) donors for HCV-positive recipients merits more detailed analysis.
  
  
  METHODS
  Using UNOS registry data of all liver transplantations performed during the Model for End-Stage Liver Disease era from February 2002 through November 2007, we analyzed graft survival using Kaplan-Meier and Cox regression analyses.
  
  
  RESULTS
  Of the 12,543 HCV-positive recipients, 2,543 received HBcAb(-) livers and 853 received HBcAb(+) livers. While Kaplan-Meier analysis showed significantly lower graft survival among HCV-negative recipients of HBcAb(+) livers (P = .0001), there was no significant effect on graft survival among the HCV-positive population (P = .2). To detect an early effect in HCV-positive recipients, we examined 1-year graft survival, observing no significant difference (P = .3). To exclude a possible late effect, we examined graft survival in the HCV-positive population conditional upon surviving at least 1 year after transplantation; no significant difference was observed (P = .6). The elimination of potentially confounding codiagnoses, such as hepatitis B virus, alcoholism, acute graft failure, and hepatocellular cancer did not alter the findings. On univariate analysis, the lack of a significant effect persisted among the HCV population. However, the significant effect observed in the univariate model for the HCV-negative population became insignificant when combined with other risk factors in the multivariate model.
  
  
  CONCLUSIONS
  The use of HBcAb(+) livers in recipients with HCV did not appear to have a significant impact on graft survival.
authors.affiliation: Department of Surgery, University of Washington, Seattle, Washington 98195-6175, USA. rayhills@u.washington.edu
authors.forename: S
authors.initials: S
authors.lastname: Rayhill
authors.forename: J
authors.initials: J
authors.lastname: Schwartz
authors.forename: J
authors.initials: J
authors.lastname: Ham
authors.forename: R
authors.initials: R
authors.lastname: Carithers
authors.forename: Y
authors.initials: Y
authors.lastname: Lei
authors.forename: R
authors.initials: R
authors.lastname: Bhattacharya
authors.forename: I
authors.initials: I
authors.lastname: Liou
authors.forename: C
authors.initials: C
authors.lastname: Landis
authors.forename: A
authors.initials: A
authors.lastname: Lamaye
authors.forename: R
authors.initials: R
authors.lastname: Rakita
authors.forename: A
authors.initials: A
authors.lastname: Dick
authors.forename: P
authors.initials: P
authors.lastname: Healey
authors.forename: J
authors.initials: J
authors.lastname: Halldorson
authors.forename: R
authors.initials: R
authors.lastname: Bhakthavatsalam
authors.forename: J
authors.initials: J
authors.lastname: Perkins
authors.forename: J
authors.initials: J
authors.lastname: Reyes
mesh_terms: D006085:Graft Survival; D006510:Hepatitis B Antibodies / Q000276:immunology*; D006512:Hepatitis B Core Antigens / Q000276:immunology*; D006526:Hepatitis C / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens