Utilization of hepatitis B core antibody-positive donor liver grafts

Malcolm P. MacConmara, Neeta Vachharajani, Jason R. Wellen, Christopher D. Anderson, Jeffrey A. Lowell, Surendra Shenoy, William C. Chapman, Maria B Majella Doyle

Research output: Contribution to journalArticle

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Abstract

Background: The inclusion of hepatitis B core antibody-positive (HBcAb+) liver donors is a strategy utilized to increase organ availability. This study examined HBcAb+ transplantation practices to identify specific factors influencing outcomes. Methods: Twenty-five HBcAb+ liver transplants were identified retrospectively among 868 adult transplants performed between 1 January 1997 and 31 December 2009. Twelve (48%) recipients had hepatitis C and five (20%) had hepatitis B. Patient and donor demographics, preoperative morbidity, transplant data and outcomes were examined. Statistical analysis was completed using Student's t-test or the Kaplan-Meier method. A P-value of <0.05 was considered significant. Results: There was no difference in age, body mass index or comorbidities between HBcAb+ liver recipients and control subjects. Model for End-stage Liver Disease (MELD) scores of >30 were significantly more frequent in HBcAb+ liver recipients (32% vs. 15%; P= 0.04). All patients received immunoglobulin and longterm antiviral therapy as prophylaxis against graft hepatitis B resurgence. No patients who received HBcAb+ livers developed hepatitis B infection on follow-up. Overall survival at 30 days, 1 year and 5 years in HBcAb+ liver recipients was 92%, 74% and 74%, respectively, compared with 96%, 89% and 76%, respectively, in the control group (P= not significant, log-rank test). All except one of the deaths in the HBcAb+ liver recipient group occurred within 90 days postoperatively and in patients with MELD scores >30. Conclusions: The practice of transplanting HBcAb+ grafts incurs low risk for infection using current methods of prophylaxis. The highest mortality risk was in the early postoperative period, specifically in patients with very high MELD scores. This probably reflects the practice of using positive serology grafts in emergent situations.

Original languageEnglish (US)
Pages (from-to)42-48
Number of pages7
JournalHPB
Volume14
Issue number1
DOIs
StatePublished - Jan 2012

Fingerprint

Hepatitis B Antibodies
Tissue Donors
Transplants
Liver
Hepatitis B
Kaplan-Meier Estimate
Serology
Hepatitis C
Infection
Postoperative Period
Antiviral Agents
Immunoglobulins
Transplantation
Demography
Students
Morbidity
Control Groups
Survival
Mortality

Keywords

  • Donor
  • Hepatitis B
  • Liver transplantation

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

MacConmara, M. P., Vachharajani, N., Wellen, J. R., Anderson, C. D., Lowell, J. A., Shenoy, S., ... Doyle, M. B. M. (2012). Utilization of hepatitis B core antibody-positive donor liver grafts. HPB, 14(1), 42-48. https://doi.org/10.1111/j.1477-2574.2011.00399.x

Utilization of hepatitis B core antibody-positive donor liver grafts. / MacConmara, Malcolm P.; Vachharajani, Neeta; Wellen, Jason R.; Anderson, Christopher D.; Lowell, Jeffrey A.; Shenoy, Surendra; Chapman, William C.; Doyle, Maria B Majella.

In: HPB, Vol. 14, No. 1, 01.2012, p. 42-48.

Research output: Contribution to journalArticle

MacConmara, MP, Vachharajani, N, Wellen, JR, Anderson, CD, Lowell, JA, Shenoy, S, Chapman, WC & Doyle, MBM 2012, 'Utilization of hepatitis B core antibody-positive donor liver grafts', HPB, vol. 14, no. 1, pp. 42-48. https://doi.org/10.1111/j.1477-2574.2011.00399.x
MacConmara MP, Vachharajani N, Wellen JR, Anderson CD, Lowell JA, Shenoy S et al. Utilization of hepatitis B core antibody-positive donor liver grafts. HPB. 2012 Jan;14(1):42-48. https://doi.org/10.1111/j.1477-2574.2011.00399.x
MacConmara, Malcolm P. ; Vachharajani, Neeta ; Wellen, Jason R. ; Anderson, Christopher D. ; Lowell, Jeffrey A. ; Shenoy, Surendra ; Chapman, William C. ; Doyle, Maria B Majella. / Utilization of hepatitis B core antibody-positive donor liver grafts. In: HPB. 2012 ; Vol. 14, No. 1. pp. 42-48.
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abstract = "Background: The inclusion of hepatitis B core antibody-positive (HBcAb+) liver donors is a strategy utilized to increase organ availability. This study examined HBcAb+ transplantation practices to identify specific factors influencing outcomes. Methods: Twenty-five HBcAb+ liver transplants were identified retrospectively among 868 adult transplants performed between 1 January 1997 and 31 December 2009. Twelve (48{\%}) recipients had hepatitis C and five (20{\%}) had hepatitis B. Patient and donor demographics, preoperative morbidity, transplant data and outcomes were examined. Statistical analysis was completed using Student's t-test or the Kaplan-Meier method. A P-value of <0.05 was considered significant. Results: There was no difference in age, body mass index or comorbidities between HBcAb+ liver recipients and control subjects. Model for End-stage Liver Disease (MELD) scores of >30 were significantly more frequent in HBcAb+ liver recipients (32{\%} vs. 15{\%}; P= 0.04). All patients received immunoglobulin and longterm antiviral therapy as prophylaxis against graft hepatitis B resurgence. No patients who received HBcAb+ livers developed hepatitis B infection on follow-up. Overall survival at 30 days, 1 year and 5 years in HBcAb+ liver recipients was 92{\%}, 74{\%} and 74{\%}, respectively, compared with 96{\%}, 89{\%} and 76{\%}, respectively, in the control group (P= not significant, log-rank test). All except one of the deaths in the HBcAb+ liver recipient group occurred within 90 days postoperatively and in patients with MELD scores >30. Conclusions: The practice of transplanting HBcAb+ grafts incurs low risk for infection using current methods of prophylaxis. The highest mortality risk was in the early postoperative period, specifically in patients with very high MELD scores. This probably reflects the practice of using positive serology grafts in emergent situations.",
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