*Purpose: Liver grafts from donors with hepatitis B infection contributed to expand the donor pool under the Hepatitis B immunoglobulin (HBIG) and antiviral agents (NA: Nucleos(t)ide analogues) in the hepatitis B virus (HBV) endemic area. We report the long-term outcome of liver transplantation (LT) using grafts from donors with active and chronic hepatitis B virus infection

*Methods: Among 2260 LTs performed in Seoul National University (SNU) Hospital, SNU Bundang Hospital (SNUBH), and Seoul Metropolitan Government-SNU Boramae Hospital between January 2000 and April 2019, twenty-six (1.2%) grafts from donors with HBsAg (+), HBeAb (+) or HBV DNA (+) were referred as active and chronic HBV hepatitis grafts and reviewed retrospectively.

*Results: Sixteen deceased donor LT were performed with active HBsAg (+) grafts. Ten living donor LT were performed with inactive HBV infected grafts; eight patients in inactive hepatitis status; HBsAg (-), HBcAb (+) & HBV DNA (+), and two patients in chronic HBV hepatitis with seroconversion; HBsAg (-), HBsAb (+) and HBeAg (+). Recipients’ age was 59.0±10.3 years old and MELD score was 19.9±8.4. Average follow-up period was 82.6±60.1 months. NA and HBIG were administered during perioperative period depending on donor and recipient’s serology. Deaths (n=8) were occurred 2.0-47.3 months after transplantation. All deaths were reported in DDLT. When compared with the patients who underwent LT using non-hepatitis virus-infected grafts, there was no significant difference in patient survival (30.8% vs. 18.6%, p=0.247). Most common causes of death were infection (n=4) and HCC recurrence (n=3). All recurred HCC patients were died of cancer. HBV reactivation was identified in 1 patient but resolved spontaneously without additional management. All 10 LDLT recipients survived and were in good condition during follow-up. Survivors were in inactive or resolved status for HBV infection under the HBIG and NA. No graft failure was observed. Fourteen patients followed-up more than 5 years were stable and no increase in HCC recurrence rate was observed 5 years after transplantation.

*Conclusions: Considering their long-term outcome, liver grafts with active and chronic HBV infection can be safely used in HBV endemic area.

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