title: Use of hepatitis B surface antigen-positive grafts in liver transplantation: a matched analysis of the US National database.
abstract: The scarcity of available donor organs is the key challenge in orthotopic liver transplantation (OLT). A viable way of expanding the donor pool is the use of liver grafts from hepatitis B surface antigen (HBsAg)-positive donors. The present study used the US Scientific Registry of Transplant Recipients database (1987-2010), and each of the 78 patients who underwent OLT with HBsAg-positive grafts was matched with 4 patients who received HBsAg-negative grafts by urgent status, donor sex, recipient sex, donor age, recipient age, transplant date, Model for End-Stage Liver Disease score, and warm ischemia time. The overall graft and patient survival rates were similar for recipients of HBsAg-positive grafts and matched controls: the 5-year graft survival rates were 66% and 64%, respectively (P = 0.95), and the 5-year patient survival rates were 71% and 71%, respectively (P = 0.87). A Cox proportional hazards regression analysis that was adjusted for other variables showed no impact of the donor HBsAg status on graft or patient survival. The use of hepatitis B immunoglobulin (HBIG) was independently associated with better posttransplant graft survival [hazard ratio (HR) = 0.23, 95% confidence interval (CI) = 0.06-0.81] and patient survival (HR = 0.16, 95% CI = 0.04-0.75) for recipients of HBsAg-positive grafts. In conclusion, the use of HBsAg-positive liver grafts did not reduce posttransplant graft or patient survival. Moreover, matching these donors to recipients treated with HBIG may improve safety.
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery First Affiliated Hospital, School of Medicine, Zhejiang University, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou, China.
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Li
authors.forename: Zhenhua
authors.initials: Z
authors.lastname: Hu
authors.forename: Jie
authors.initials: J
authors.lastname: Xiang
authors.forename: Jie
authors.initials: J
authors.lastname: Zhou
authors.forename: Sheng
authors.initials: S
authors.lastname: Yan
authors.forename: Jian
authors.initials: J
authors.lastname: Wu
authors.forename: Lin
authors.initials: L
authors.lastname: Zhou
authors.forename: Shusen
authors.initials: S
authors.lastname: Zheng
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D016208:Databases, Factual; D058625:End Stage Liver Disease / Q000401:mortality / Q000628:therapy*; D005260:Female; D006085:Graft Survival; D006514:Hepatitis B Surface Antigens / Q000276:immunology*; D006801:Humans; D008099:Liver / Q000276:immunology*; D016031:Liver Transplantation; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States; D052096:Warm Ischemia; D055815:Young Adult
chemical_list: D006514:Hepatitis B Surface Antigens