title: Use of grafts from anti-HBc-positive donors in liver transplantation: a 5-year, single-center experience.
abstract: BACKGROUND
  Liver transplantation (OLT) is the treatment of choice for advanced hepatic disease. The growing gap between waiting list patients and the number of donations has led to acceptance of less than optimal donors. The aim of this study was to evaluate the 5-year experience with anti hepatitis B core antigen (HBc)-positive liver donors.
  
  
  METHODS
  All recipients of anti-HBc-positive grafts from January 2005 to December 2010 were evaluated annually after OLT for liver disease etiology, Model for End-Stage Liver Disease (MELD) score, and the presence of hepatocellular carcinoma (HCC) liver biopsy histology and serology for hepatitis B virus (HBsAg, anti-HBs, HBV-DNA), hepatitis C virus, and hepatitis D virus as well as antiviral prophylaxis to prevent de novo HBV.
  
  
  RESULTS
  Among the 249 OLT performed from January 2005 to December 2010, (9.3%) cases used grafts from anti-HBc-positive donors. Etiologics of liver disease among the recipients were HBV (n = 13; 32.5%), HCV (n = 13; 32.5%) or other causes (n = 14; 35%). In 20 of the 40 patients (50%), HCC was found in the explanted organ. Of 40 recipients of anti-HBc-positive grafts 11 died, and 7 (17.5%) required retransplantation. Various regimens were employed as post-transplantation antiviral prophylaxis: (l) Immune globulin (25.8%); (2) Oral antiviral drugs (9.7%); and (3) combined prophylaxis (51.6%) or no treatment (12.9%). No difference was observed in patient or graft survival in relation to the etiology of liver disease, the MELD score, or the presence of HCC at the time of OLT, except graft survival was significantly reduced among recipient who underwent transplantation for non-HBV or non-HCV liver diseases compared with those engrafted due to viral hepatitis (P = .0062). No difference was observed in histologic features (grading and staging) compared with the antiviral prophylactic therapy; the 2 patients (5%) who developed de novo HBV had not received prophylaxis after OLT.
  
  
  CONCLUSIONS
  Matching anti-HBc-positive grafts to recipients without HBV infection before OLT, may be especially safe.
authors.affiliation: Multivisceral Transplantation and Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital Padova, Padua, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Bortoluzzi
authors.forename: M
authors.initials: M
authors.lastname: Gambato
authors.forename: L
authors.initials: L
authors.lastname: Albertoni
authors.forename: C
authors.initials: C
authors.lastname: Mescoli
authors.forename: M
authors.initials: M
authors.lastname: Pacenti
authors.forename: R
authors.initials: R
authors.lastname: Cusinato
authors.forename: G
authors.initials: G
authors.lastname: Germani
authors.forename: M
authors.initials: M
authors.lastname: Senzolo
authors.forename: M
authors.initials: M
authors.lastname: Rugge
authors.forename: P
authors.initials: P
authors.lastname: Boccagni
authors.forename: G
authors.initials: G
authors.lastname: Zanus
authors.forename: U
authors.initials: U
authors.lastname: Cillo
authors.forename: P
authors.initials: P
authors.lastname: Burra
authors.forename: F P
authors.initials: FP
authors.lastname: Russo
mesh_terms: D000328:Adult; D005260:Female; D006512:Hepatitis B Core Antigens / Q000032:analysis*; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors
chemical_list: D006512:Hepatitis B Core Antigens