Survival after orthotopic liver transplantation: The impact of antibody against hepatitis B core antigen in the donor§

Authors

  • Lei Yu,

    Corresponding author
    1. Division of Gastroenterology, Department of Medicine, Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle, WA
    2. Research Enhancement Award Program, Veterans Affairs Puget Sound Health Care System, Seattle, WA
    3. Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA
    • Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356424, Seattle, WA 98195-6424
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    • Telephone: 206-650-7942

  • Thomas Koepsell,

    1. Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA
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  • Lisa Manhart,

    1. Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA
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  • George Ioannou

    1. Division of Gastroenterology, Department of Medicine, Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle, WA
    2. Research Enhancement Award Program, Veterans Affairs Puget Sound Health Care System, Seattle, WA
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  • See Editorial on Page 1164

  • This research was based on data derived from the United Network for Organ Sharing on January 18, 2007.

  • §

    The content of this work is the responsibility of the authors alone and does not necessarily reflect the views or policies of the US Department of Health and Human Services.

Abstract

Liver transplantation using grafts from donors with antibody against hepatitis B core antigen (anti-HBc) increases the recipients' risk of developing hepatitis B virus (HBV) infection post-transplantation. Our aim was to assess whether using such grafts was associated with reduced posttransplantation survival and whether this association depended on recipients' prior exposure to HBV on the basis of their pretransplantation serological patterns. Data were derived from the United Network for Organ Sharing on adult, cadaveric, first-time liver transplants performed between 1994 and 2006. Among recipients who did not have HBV infection before transplantation, those with anti-HBc–positive donors had significantly worse unadjusted posttransplantation patient survival than recipients with anti-HBc–negative donors [hazard ratio, 1.35; 95% confidence interval (CI), 1.21-1.50]. However, after adjustments for other predictors of posttransplantation survival, including donor age, donor race, and recipient underlying liver diseases, patient survival was not significantly different between the 2 groups (hazard ratio, 1.09; 95% CI, 0.97-1.24). Among recipients without antibody against hepatitis B surface antigen (anti-HBs), use of anti-HBc–positive donor grafts was associated with a trend toward worse survival (adjusted hazard ratio, 1.18; 95% CI, 0.95-1.46), whereas no such trend was observed among recipients positive for anti-HBs. In conclusion, in patients without HBV infection before transplantation, using anti-HBc–positive donors was not independently associated with worse posttransplantation survival. Matching these donors to recipients with anti-HBs pre-transplantation may be especially safe. Liver Transpl 15:1343–1350, 2009. © 2009 AASLD.

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