J Viral Hepat. 2018 Feb 12. doi: 10.1111/jvh.12880. [Epub ahead of print]
Viral activity and outcome of hepatitis B surface antigen-positive grafts in deceased liver transplantation.Lee WC1, Chou HS1, Lee CS2, Wu TH1, Wang YC1, Cheng CH1, Lee CF1, Wu TJ1, Chan KM1. Author information 1Departments of Liver and Transplantation Surgery and Chang, Gung University College of Medicine, Taoyuan, Taiwan.2Hepatology, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan.
AbstractIndications of liver transplantation are extensive, but deceased donation does not meet the demand. Hepatitis B surface antigen (HBs Ag)-positive grafts used to be discarded in the past. The aim of this study is to examine viral activity and outcome of HBsAg-positive deceased grafts transplanted to HBsAg-positive recipients. Eleven HBsAg-positive deceased grafts were transplanted to HBsAg-positive patients with acute liver failure (3 patients), hepatocellular carcinoma (6 patients) and repeatedly bleeding varices (2 patients). Postoperatively, hepatitis B virus (HBV) infection was treated by a combination of anti-viral nucleoside and nucleotide analogues. HBV DNA and HBsAg were measured periodically. The median (interquartile) model of end stage liver disease score for the recipients was 19 (16-32) with a range from 11 to 40. HBV DNA was detected in 6 patients with a range from 61 to 1083 IU/ml before transplantation. After transplantation, HBV DNA was detected in 4 patients in the first month, 2 patients in the 6th month and became undetectable for all patients at end of the first year. The quantitative HBsAg ranged from 0.86 to 241.1IU/ml at 6 months and 0.34 to 238.5U/ml at 24 months (p = 0.135). Three of the patients died in the early phase and the other patients were followed up for 40.0±19.2 months with normal liver function. In conclusion, HBsAg-positive deceased liver grafts function well with minimal viral activity under treatment of combined anti-viral nucleoside and nucleotide analogues. Use of HBsAg-positive deceased grafts is feasible and increases the donor pool to rescue dying patients. This article is protected by copyright. All rights reserved.