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

초록

Background: 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. Methods: 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 (-) & HBcAb (+) (n=882, C (+) group) and HBsAg (-) & 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), preoperative 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). Conclusions: HBsAg (+) liver grafts can expand the donor pool without compromising the outcomes in the era of NA in the HBV endemic area.