Outcomes of hepatitis C- and hepatitis B core antibody-positive grafts in orthotopic liver transplantation

The use of hepatitis B core antibody (HBcAb)- and hepatitis C virus antibody (HCV⁺) liver grafts for transplantation in selected populations has not affected patient and graft survival. We reexamined the clinical outcomes of using these HBcAb⁺ and HCV⁺ grafts at our institution, in addition to studying recipients of combined HBcAb⁺/ HCV⁺ grafts. We identified 377 patients who underwent transplantation for either hepatitis B and/or hepatitis C, or received both HBcAb⁺ and HCV⁺ grafts. Patient and graft survival at 5 years posttransplantation was 73% and 71%, respectively, in the HBcAb⁺ grafts compared with 81% and 75% in the HBcAb^- grafts (P =.65; P =.94). For HCV⁺ grafts, patient and graft survival at 5 years posttransplantation was 89% and 73%, respectively, compared with 69% and 59% in the HCV^- grafts; (P =.22; P =.77). The 5-year patient and graft survival rate in those who received combined HBcAb⁺/HCV⁺ grafts was 74% and 69%, respectively, and there was no statistical difference compared with the HBcAb⁺ and HCV⁺ grafts (P =.76; P =.90). The 5-year patient and graft survival rate in patients who received dual HBV prophylaxis with hepatitis B immunoglobulin (HBIg) and lamivudine was 88% and 84%, respectively, which was significantly higher than for patients who received single prophylaxis or no prophylaxis (P <.01; P =.02). Our study supports previous observations that patient and graft survival is not affected with the use of HBcAb⁺ and HCV⁺ grafts, and that dual prophylaxis with HBIg and lamivudine offers substantial survival benefits. Furthermore, the use of combined HBcAb⁺/HCV⁺ grafts did not impact patient or graft survival. This provides a potential new pool of donor livers that can be used for transplantation in select patients.