*Purpose: The use of hepatitis B (HBV) core antibody positive (HBcAb+) donor allografts in liver transplantation (OLT) has become accepted practice; however, given limited data on use of HBV nucleic acid testing positive (NAT+) donors, we aimed to compare recipient outcomes with utilization of HBcAb+/NAT+ vs HBcAb+/NAT- donor allografts.

*Methods: A prospectively maintained single-institution database was queried for patients undergoing OLT with HBcAb+ donors between January 1, 2013 and June 30, 2018. A protocol regarding HBV donors was initiated at our institution in 2013 and appropriate consents obtained. Preoperative active HBV in the recipient was defined as HBsAg+. Postoperative active HBV was defined as HBV NAT+. All patients who received HBcAb+ donor livers were placed on entecavir postoperatively for life regardless of HBV status. Susceptible recipients (non-immune and HBV-naive) of a NAT+ liver also received HBIG.

*Results: Of 485 transplants, 9 donors were HBcAb+/NAT+ and 39 were HBcAb+/NAT-. The NAT+ donors were more likely to be younger than the NAT- donors (32 vs 50 years, p=0.001) but otherwise the groups were similar in donor, recipient, operative, or postoperative factors. In the NAT+ group, 4 were immune, 1 had active HBV, and 4 were susceptible. At median follow-up of 14 months, 7 of the 9 remain without HBV recurrence (NAT-), including the recipient with active disease preoperatively, with 2 yet to undergo surveillance. In the NAT- group, 16 recipients were immune, 1 had active HBV, and 22 were susceptible. At median follow-up of 18 months, the recipient with active HBV preoperatively was the only recipient with active HBV postoperatively (1/39, 2.6%). There was 1 NAT+ patient with early allograft dysfunction and bile leak. Complications in the NAT- recipients included early allograft dysfunction (n=1), hepatic artery thrombosis (n=1), bile leak (n=5) and biliary anastomotic stricture (n=5). There was no significant difference between NAT+ and NAT- groups in 1-year graft survival (100% vs 84.8%, p=0.22) or patient survival (100% vs 84.8%, p=0.22).

*Conclusions: In the largest case series to date, our experience demonstrates short-term safety and clinical effectiveness of viremic HBV donor utilization in liver transplantation. Use of these donors should be considered to address the organ shortage dilemma.

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