title: Hepatitis B-core antibody positive donors in liver transplantation and their impact on graft survival: evidence from the Liver Match cohort study.
abstract: OBJECTIVE
  The appropriate allocation of grafts from HBcAb positive donors in liver transplantation is crucial, yet a consensus is still lacking.
  
  
  METHODS
  We evaluated this issue within Liver Match, a prospective observational Italian study. Data from 1437 consecutive, first transplants performed in 2007-2009 using grafts from deceased heart beating donors were analyzed (median follow-up: 1040 days). Of these, 219 (15.2%) were HBcAb positive. Sixty-six HBcAb positive grafts were allocated to HBsAg positive and 153 to HBsAg negative recipients.
  
  
  RESULTS
  329 graft losses occurred (22.9%): 66 (30.1%) among 219 recipients of HBcAb positive grafts, and 263 (21.6%) among 1218 recipients of HBcAb negative grafts. Graft survival was lower in recipients of HBcAb positive compared to HBcAb negative donors, with unadjusted 3-year graft survival of 0.69 (s.e. 0.032) and 0.77 (0.013), respectively (log-rank, p=0.0047). After stratifying for recipient HBsAg status, this difference was only observed among HBsAg negative recipients (log rank, p=0.0007), 3-year graft survival being excellent (0.88, s.e. 0.020) among HBsAg positive recipients, regardless of the HBcAb donor status (log rank, p=0.4478). Graft loss due to de novo HBV hepatitis occurred only in one patient. At Cox regression, hazard ratios for graft loss were: MELD (1.30 per 10 units, p=0.0002), donor HBcAb positivity (1.56, p=0.0015), recipient HBsAg positivity (0.43, p <0.0001), portal vein thrombosis (1.99, p=0.0156), and DRI (1.41 per unit, p=0.0325).
  
  
  CONCLUSIONS
  HBcAb positive donor grafts have better outcomes when transplanted into HBsAg positive than HBsAg negative recipients. These findings suggest that donor HBcAb positivity requires more stringent allocation strategies.
authors.affiliation: Liver Unit, Tor Vergata University, Rome, Italy. angelico@med.uniroma2.it
authors.forename: Mario
authors.initials: M
authors.lastname: Angelico
authors.forename: Alessandra
authors.initials: A
authors.lastname: Nardi
authors.forename: Tania
authors.initials: T
authors.lastname: Marianelli
authors.forename: Lucio
authors.initials: L
authors.lastname: Caccamo
authors.forename: Renato
authors.initials: R
authors.lastname: Romagnoli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tisone
authors.forename: Antonio D
authors.initials: AD
authors.lastname: Pinna
authors.forename: Alfonso W
authors.initials: AW
authors.lastname: Avolio
authors.forename: Stefano
authors.initials: S
authors.lastname: Fagiuoli
authors.forename: Patrizia
authors.initials: P
authors.lastname: Burra
authors.forename: Mario
authors.initials: M
authors.lastname: Strazzabosco
authors.forename: Alessandro Nanni
authors.initials: AN
authors.lastname: Costa
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D046148:Donor Selection / Q000379:methods*; D005260:Female; D006085:Graft Survival; D006509:Hepatitis B / Q000517:prevention & control; D006510:Hepatitis B Antibodies / Q000097:blood*; D006512:Hepatitis B Core Antigens / Q000276:immunology; D006801:Humans; D007558:Italy; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014019:Tissue Donors
chemical_list: D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens