*Purpose: In an effort to expand the pool of solid organ transplant donors, patients with end stage liver disease may receive an organ from a donor with a history of hepatitis B virus (HBV) infection. With hepatitis B immune globulin (HBIG) and antiviral therapy, improved rates of patient and graft survival have been shown. The goal of this analysis is to assess current strategies for preventing breakthrough HBV infections in patients who receive a HBV core antibody positive (HBcAb+) liver and to compare graft and patient outcomes to those who received an HBcAb negative (HBcAb-) liver.

*Methods: This study was a retrospective chart review of liver transplant recipients from January 1st, 2014 through August 30th, 2020. The primary outcome was breakthrough HBV infection within the first 12 months post-transplant. Secondary outcomes included graft and patient survival for the first 12 months post-transplant. Recipients of an HBcAb+ liver were matched in a 1:2 fashion to a control group of HBcAB- liver transplant recipients. Propensity score matching was based on age, gender, race, body mass index (BMI), history of diabetes, MELD-Na score, serum creatinine, and albumin at the time of transplant.

*Results: Thirty three patients met criteria for the experimental group and were matched to 66 control patients. There were no documented cases of breakthrough HBV infections in HBcAb+ patients. Twenty-two HBcAb+ patients received antiviral prevention (lamivudine 30%, entecavir 9%, and tenofovir 27%), four of which also received HBIG. One patient received HBIG alone. There was no difference in patient survival between the experimental and control groups (94% vs. 94%, respectively). Graft survival was comparable (91% and 96%, respectively). Four HBcAb+ patients (12%) had one episode of rejection within the first year; only one control patient had rejection (3%).

*Conclusions: Our insitution’s current approach to HBV post-exposure prophylaxis was effective during this time frame as no HBcAb+ patients had documented breakthrough HBV infections within the first 12 months post-transplant. Similar patient and graft survival rates were seen among the control and experimental groups. Given the variability in prescribing practices of antiviral and HBIG therapy, a more protocolized approach could be beneficial.

« Back to 2022 American Transplant Congress