Inferior graft survival of hepatitis B core positive grafts is not influenced by post-transplant hepatitis B infection in liver recipients--5-year single-center experience

Transpl Int. 2016 Apr;29(4):471-82. doi: 10.1111/tri.12741. Epub 2016 Feb 1.


Nonoptimal liver grafts, and among them organs from anti-HBc+ donors, are increasingly used for liver transplantation. In this retrospective study including 1065 adult liver transplantations performed between 1977 and 2012, we analyzed long-term patient and graft survival and occurrence of HBV infection. A total of 52 (5.1%) patients received an anti-HBc+ graft. The 10-year graft and patient survival of these recipients were 50.9% and 59.0% compared to 72.0% and 76.5% (P = 0.001; P = 0.004) of patients receiving anti-HBc- grafts, respectively. Cox regression model showed that high urgency allocation (P = 0.003), recipient age (P = 0.027), anti-HCV+ recipients (P = 0.005), and anti-HBc+ organs (P = 0.048) are associated with decreased graft survival. Thirteen of 52 (25.0%) patients receiving anti-HBc+ grafts developed post-transplant HBV infection within a mean of 2.8 years. In this study, antiviral prophylaxis did not have significant impact on HBV infection, but long-term survival (P = 0.008). Development of post-transplant HBV infection did not affect adjusted 10-year graft survival (100% vs. 100%; P = 1). Anti-HBc+ liver grafts can be transplanted with reasonable but inferior long-term patient and graft survival. The inferior graft survival is not, however, related with post-transplant HBV infection as long as early diagnosis and treatment take place.

Keywords: Lamivudine resistance; anti-HBc+ grafts; antiviral prophylaxis; post-transplant HBV infection.

MeSH terms

  • Adult
  • Aged
  • Antiviral Agents / therapeutic use
  • Female
  • Graft Survival*
  • Hepatitis B / pathology*
  • Hepatitis B Antibodies / blood
  • Hepatitis B Core Antigens / blood
  • Hepatitis B Surface Antigens / blood
  • Humans
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Proportional Hazards Models
  • Prospective Studies
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Tissue Donors
  • Tissue and Organ Procurement
  • Treatment Outcome
  • Viral Load


  • Antiviral Agents
  • Hepatitis B Antibodies
  • Hepatitis B Core Antigens
  • Hepatitis B Surface Antigens