Safe use of hepatitis B surface antigen positive (HBsAg (+)) grafts in liver transplantation (LT): a nationwide study based on KOTRY (Korean Organ Transplantation Registry) data

Abstract

Background and aims: In the era of nucleos (t)ide analogues (ANs), we investigate the outcomes of liver transplantation (LT) using HBsAg (+) grafts using Korean national registry database.

Method: Among 4265 LTs which were registered in KOTRY database between April 2014 and January 2020, 20 (0.5%) LTs using HBsAg (+) grafts were identified. We investigated the overall outcomes of LT using HBsAg (+) liver grafts (n = 4100, S (+) group) compared to those of HBsAg (−) liver grafts. S (+) group were compared to those for LT using HBsAg (−) and HBcAb (+) (n = 882, C (+) group) and HBsAg (−) and HBcAb (−) (n = 3132, SC (−) group) after propensity-score matching (1:1).

Results: Twenty HBsAg (+) grafts from deceased donors were transplanted to HBsAg (+) recipients. HBIG was maintained in 16 patients (80%). Most common NA was tenofovir. S (+) group showed comparable patient survival (26.5 ± 21.8 vs 22.8 ± 18.2 months, p = 0.332) and graft survival (26.5 ± 21.8 vs 21.3 ± 18.2 months, p = 0.152) compared to those of HBsAg (-) group. Age (HR = 1.03, p = 0.016), HCC (HR = 4.61, p < 0.001), MELD score (HR = 2.82, p = 0.001), ascites (HR = 2.14, p = 0.002) and encephalopathy (HR = 2.53, p < 0.001) were the risk factors affecting patient survival. For graft survival, HCC (HR = 4.01, p = 0.001), pre-operative treatment to HCC (HR = 0.54, p = 0.006), MELD score (HR = 2.14, p = 0.012), ascites (HR = 2.52, p < 0.001), and encephalopathy (HR = 1.99, p < 0.001) were significant factors. After PSM matching between S (+) and C (+), and S (+) and SC (−), there was no significant difference in patient survival (24.3 ± 20.7 vs 38.2 ± 23.0 months, p = 0.863, 24.3 ± 2.7 vs 38.2 ± 23.0 months p = 0.547), and graft survival (26.5 ± 21.8 vs 36.3 ± 17.4 months, p = 0.576, 26.5 ± 21.8 vs 36.3 ± 18.4 months, p = 0.327, respectively).

Conclusion: HBsAg (+) liver grafts can expand the donor pool without compromising the outcomes in the era of NA in the HBV endemic area.