Use, Safety and Effectiveness of Hepatitis B Virus NAT-Positive Donor Livers in the Current Era
University of Cincinnati, Cincinnati, OH
Meeting: 2019 American Transplant Congress
Abstract number: C272
Keywords: Liver grafts, Liver transplantation, Waiting lists
Session Information
Session Name: Poster Session C: Liver: MELD, Allocation and Donor Issues (DCD/ECD)
Session Type: Poster Session
Date: Monday, June 3, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*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.
To cite this abstract in AMA style:
Lee TC, Safdar K, Winer LK, Morris MC, Kassam A, Luckett K, III RQuillin, Bari K, Anwar N, Shah SA. Use, Safety and Effectiveness of Hepatitis B Virus NAT-Positive Donor Livers in the Current Era [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/use-safety-and-effectiveness-of-hepatitis-b-virus-nat-positive-donor-livers-in-the-current-era/. Accessed December 10, 2024.« Back to 2019 American Transplant Congress