Outcomes of Liver Transplantation from Hepatitis B CoreAntibody–Positive Donors in Viral Cirrhosis Patients: The PrevailingNegative Effect of Recipient Hepatitis C Virus Infection

Background. Liver transplantation (LT) with grafts from hepatitis B core antibody (HBcAb)–positive donors has been the object of recent studies, suggesting different outcomes depending on the etiology of viral cirrhosis in the recipient. Methods. From November 2002 to December 2009, we transplanted 124 livers from hepatitis B surface antigen (HBsAg)–negative HBcAb-positive deceased heart-beating donors to adult recipients with viral cirrhosis, classified as: HBsAg positive (group 1; n=63); hepatitis C virus (HCV) RNA positive (group 2; n=52); and simultaneously HBsAg and HCV-RNA positive (group 3; n=9). Immunosuppression included a calcineurin inhibitor, mycophenolate, and steroids (tapered to suspension in 6 months). In all groups, anti-HBV prophylaxis was performed with anti-HBs immunoglobulins and nucleos(t)idic analogues. Results. The groups were similar regarding donor, recipient, donor-recipient match, transplant procedure, variables, and treatment of acute rejection, except for younger recipient age in group 1 (P .009), lower recipient body mass index in group 3 (P .03), and longer cold ischemia time in group 2 (P .003). Median follow-up for surviving grafts was 63 (range, 16–102) months. No case of recurrent or de novo hepatitis B occurred. The prevalence of histologically proven recurrent HCV hepatitis was similar in groups 2 and 3 (65% vs 78%). Graft survival at 5 years was 86% in group 1, 35% in group 2, and 31% in group 3 (P .0001 for group 1 vs 2; P .01 for group 1 vs 3). On multivariate analysis, independent predictors of worse graft survival were HCV infection in the recipient (HR 8.08, 95% CI 3.36 –17.97; P .0001) and MELD at LT > 25 (HR 3.72, 95% CI 1.12–12.37; P .032). Conclusions. The presence of HCV infection in the recipient is the factor which most negatively influenced the outcome of LT using grafts from HBcAb-positive donors. Allocation of such grafts should consider the type of viral cirrhosis among LT candidates.