Liver transplantation from brain-dead donors with hepatitis B or C in South Korea: a 2014–2021 Korean Organ Transplantation Registry data analysis

Abstract

Background:In Korea, due to the Korean Network for Organ Sharing (KONOS) guidelines, brain-dead donor liver/kidney transplantation from hepatitis B or C positive donors can be implemented only to identical hepatitis-positive recipients. However, in the US, it has been more than 15 years since organ transplantation from hepatitis-positive donors to negative recipients had been implemented. Korea also needs to discuss transplantation safety from hepatitis B or C positive donors to hepatitis negative recipients. But we cannot get the results due to the KONOS guidelines. Instead, we studied transplantation results from hepatitis B or C positive donors to each hepatitis negative recipient as a starting point to support expanding indication criteria. Methods: This is a retrospective, observational study using data from Korean Organ Transplantation Registry (KOTRY) data analysis. A total of 1,035 liver transplantations from brain-dead donors, from April 2014 to March 2021 were included in this study. It consists of 24 HBV (+) grafts, one HCV (+) graft and 1,010 hepatitis (-) grafts. Results:In donor characteristics, the rate of the standard donor was higher in hepatitis (-) donors than HBV (+) donors (735/274, 11/13; P<0.01). In recipient characteristics, median model for end-stage liver disease (MELD) score (baseline) of HBV (+), HCV (-), hepatitis (-) were 22.4±9.3, 16 and 33.0±15.4, respectively (HBV [+]-hepatitis [-], P<0.01). Median MELD score (KONOS final) were 27.8±7.8, 11 and 35.5±7.1, respectively (HBV [+]-hepatitis [-] and HCV [-]-hepatitis [-], P<0.01, respectively). From a Kaplan-Meier analysis, overall patient survival rate after LT at 5 years were 85.6%, N/A (2-year patient survival rate 100%) and 76.7%, respectively and showed no statistically significant differences (HBV [+]-HCV [+], P=0.695; HCV [+]-hepatitis [-], P=0.638; HBV [+]-hepatitis [-], P=0.383). Overall graft survival rates after LT at 5 years was 87.5%, N/A (2-year patient survival rate 100%) and 76.6%, respectively and showed no statistically significant differences. Conclusions: There were no significant differences in the 5-year transplantation patient/graft survival rate between HBV (+), HCV (+) and hepatitis (-) grafts. One more step, it's time to consider implementing transplantation from hepatitis (+) donors to hepatitis (-) recipients.