title: Utilization of hepatitis B core antibody-positive donor liver grafts.
abstract: BACKGROUND
  The inclusion of hepatitis B core antibody-positive (HBcAb+) liver donors is a strategy utilized to increase organ availability. This study examined HBcAb+ transplantation practices to identify specific factors influencing outcomes.
  
  
  METHODS
  Twenty-five HBcAb+ liver transplants were identified retrospectively among 868 adult transplants performed between 1 January 1997 and 31 December 2009. Twelve (48%) recipients had hepatitis C and five (20%) had hepatitis B. Patient and donor demographics, preoperative morbidity, transplant data and outcomes were examined. Statistical analysis was completed using Student's t-test or the Kaplan-Meier method. A P-value of <0.05 was considered significant.
  
  
  RESULTS
  There was no difference in age, body mass index or comorbidities between HBcAb+ liver recipients and control subjects. Model for End-stage Liver Disease (MELD) scores of >30 were significantly more frequent in HBcAb+ liver recipients (32% vs. 15%; P= 0.04). All patients received immunoglobulin and longterm antiviral therapy as prophylaxis against graft hepatitis B resurgence. No patients who received HBcAb+ livers developed hepatitis B infection on follow-up. Overall survival at 30 days, 1 year and 5 years in HBcAb+ liver recipients was 92%, 74% and 74%, respectively, compared with 96%, 89% and 76%, respectively, in the control group (P= not significant, log-rank test). All except one of the deaths in the HBcAb+ liver recipient group occurred within 90 days postoperatively and in patients with MELD scores >30.
  
  
  CONCLUSIONS
  The practice of transplanting HBcAb+ grafts incurs low risk for infection using current methods of prophylaxis. The highest mortality risk was in the early postoperative period, specifically in patients with very high MELD scores. This probably reflects the practice of using positive serology grafts in emergent situations.
authors.affiliation: Section of Transplant Surgery, Department of Surgery, Washington University in St Louis, MO 63110, USA.
authors.forename: Malcolm P
authors.initials: MP
authors.lastname: MacConmara
authors.forename: Neeta
authors.initials: N
authors.lastname: Vachharajani
authors.forename: Jason R
authors.initials: JR
authors.lastname: Wellen
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Anderson
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Lowell
authors.forename: Surendra
authors.initials: S
authors.lastname: Shenoy
authors.forename: William C
authors.initials: WC
authors.lastname: Chapman
authors.forename: Maria B Majella
authors.initials: MB
authors.lastname: Doyle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058625:End Stage Liver Disease / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000276:immunology*; D006510:Hepatitis B Antibodies / Q000032:analysis* / Q000276:immunology; D006515:Hepatitis B virus / Q000276:immunology*; D019694:Hepatitis B, Chronic / Q000276:immunology / Q000635:transmission / Q000821:virology*; D006801:Humans; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014019:Tissue Donors; D055815:Young Adult
chemical_list: D006510:Hepatitis B Antibodies