Introduction

Due to organ shortage the use of so called „marginal livers“ is increasing in deceased donor liver transplantation. Herein we investigate the long term outcome of recipients of grafts from Hepatitis B core positive donors and the impact of antiviral prophylaxis.

Methods

Retrospective study including 1167 liver transplants performed at our centre between 4/1977 and 3/2012. Primary endpoints were patient and graft survival. Secondary endpoint was occurrence of HBV infection (positive HBV PCR). The median follow up of the patients was 4,4 years. Statistics were carried out by Kaplan Meier analysis, ANOVA and Mann-Whitney-test.

Results

59 (5%) antiHBc+ liver grafts were transplanted to antiHBc- (54%) or antiHBc+ recipients (45%). 5-year graft- and patient-survival were 64%  and 79% respectively. 28% of all patients receiving antiHBc+ grafts became HBV PCR+ post transplant (23% de novo, 5% recurrence), occurring after a mean of 2,7 years. 0% of recipients with antiHBs >100 iU/ml at the time of transplantation became HBV PCR+ in the postoperative course compared to 25% with antiHBs <100iU/ml. Perioperatively Hepatitis B immunoglobulin (HBIg; 10000 IU/day until antiHBs titer was >500iU/ml) was administered in 47% of HBsAg- patients. Lamivudin was administered in 46%, Tenofovir in 5% of all patients. In HBsAg- recipients, HBIg monotherapy resulted in 50%, Lamivudin monotherapy in 33%, combined (Lamivudin/Tenofovir plus HBIg) in 11% and no treatment at all in 35% HBV+ PCR post transplant.

Conclusions

AntiHBc+ livers can be transplanted with reasonable long term patient and graft survival. AntiHBc+ liver grafts should primarily be allocated to patients with antiHBs >100iU/ml. Antiviral prophylaxis should be carried out with Lamivudin/Tenofovir plus HBIg in HBsAg- patients.

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