The impact of anti-hepatitis Be positive graft on the outcome of liver transplantion for hbv-related cirrhosis

ABSTRACT

The scarcity of organ donors requires consideration of marginal organs. The aim of this study was to evaluate the impact of anti HB core positive ( anti HBc +) graft donor status on patients transplanted for Hepatitis B HBV related cirrhosis. Recipients of first hepatic allograft from donor with antibiodies to HBV were identified retrospectively. All patients who had positive serology for HBV and were nwgative for Hepatitis C and D were included in the analysis. Kaplan meier methods were used to asses the actuarial recurrence free survival on patients with graft survival longer than 1,5 months. The Stepwise Cox Regression Model was used to identify independent predictors of HBV recurrence. 1717 first liver transplant were perfomed in our institution from September 1, 1990 to December 31, 1999. HBV was the cause of cirrhosis in 112 patients (6.5 per cents). 69 patients survived over 1,5 months. 33 patients had coexistent viral infection (23 HCB and 10 HDV). 14 donors (17.2 per cents) were positive for HBV markers, 9 anti-HBc + and 5 anti-HBc + and anti HBs +. 13 anti HBc + organ recipients met inclusion criteria. Nine (69.2 per cents) of these cases were re-infected vs. 20 (35.7 per cents) in the group that received graft from HBV negative donors (p<0.05, Fischer's Exact). The time to re-infection was briefer in the anti HBc + group (2.9 yr v 6,4 yr, p= 0.05). There were no diggerences in graft or patients survival between the two groups. HBV prophylaxis with combined lamivudine and HBIG significantly reduced the re-infection rate (p<0.03). hBeAg + recipients trenled to faster re infection (N.S). Cox Regression analysis revealed that both anti HBc graft donor status (HR 2,796, p=0.0020) and combination of lamivudine/HBIG (HR 0.249, p=0.021 are independently associated with re infection. The use of anti-HBc + liver graft does not affect graft or patient survival. However, patients who receive these organs are 2.5 times more likely to develop HBV recurrence. Lamivudine/HBIG combination decreases HBV recurrence fourfold