Safe Use of Hepatitis B Surface Antigen-Positive Grafts in Liver Transplantation: A Nationwide Study Based on the KOTRY Data

Abstract

In the era of nucleoside analogs (NA), we investigated liver transplantation (LT) outcomes using hepatitis B surface antigen (HBsAg)-positive(+) grafts and Korean Organ Transplantation Registry (KOTRY) data. The KOTRY database registered 4,265 LTs between April 2014 and January 2020; 20 (0.5%) using HBsAg(+) grafts were identified. HBsAg(+) liver grafts [S(+)] were compared to HBsAg-negative(−) liver grafts (n = 4,100) for LT outcomes. The S(+) group was compared with LTs using HBsAg(−)/hepatitis B core antibody (HBcAb) (+) [C(+), n = 882] and HBsAg(−)/HBcAb(−) [SC(−), n = 3,132] grafts by propensity score matching (PSM) (1:1). Sixteen of 20 HBsAg(+) graft recipients maintained hepatitis B immunoglobulin. Tenofovir is the most commonly used NA. Compared to the HBsAg(II) group, the S(+) group showed no significant differences in patient (P = 0.332) or graft survival (P = 0.152). Age (hazard ratio [HR] = 1.03, P = 0.016), hepatocellular carcinoma (HCC) (HR = 4.61, P < 0.001), the model for end-stage liver disease (MELD) score (HR = 2.82, P = 0.001), ascites (HR = 2.14, P = 0.002), and encephalopathy (HR = 2.53, P < 0.001) were risk factors for patient survival. The graft survival risk factors were HCC (HR = 4.01, P = 0.001), preoperative treatment for 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). PSM between groups S(+) and C(+) and groups S(+) and SC(−) revealed no significant difference in patient survival (P = 0.863 and P = 0.547, respectively) or graft survival (P = 0.576 and P = 0.327, respectively). In hepatitis B virus (HBV)-endemic areas, HBsAg(+) liver grafts can expand the donor pool without compromising outcomes.