Outcomes of Liver Transplantation in Simultaneously Hepatitis B Surface Antigen and Hepatitis C Virus RNA Positive Recipients: The Deleterious Effect of Donor Hepatitis B Core Antibody Positivity

• Published in: Transplantation proceedings Vol. 44; no. 7; pp. 1960 - 1962
• Main Authors: Tandoi, F, Romagnoli, R, Martini, S, Mazza, E, Nada, E, Cocchis, D, Lupo, F, Salizzoni, M
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Inc 01.09.2012; Elsevier
• Subjects: Aged; Biological and medical sciences; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hepacivirus - genetics; Hepacivirus - immunology; Hepatitis B - immunology; Hepatitis B Surface Antigens - blood; Human viral diseases; Humans; Infectious diseases; Liver Transplantation; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tissue Donors; Tissue, organ and graft immunology; Treatment Outcome; Viral diseases; Viral hepatitis; Suboptimal donor; Prognosis; RNA; Liver; Hepatic disease; Homotransplantation; Viral hepatitis B; Surgery; Evolution; Graft; Viral hepatitis C; Human; Hepatitis B surface antigen; Digestive system; Antibody; Recipient; Infection; Virus; Medicine; Treatment; Viral disease; Digestive diseases; Flaviviridae; Hepatitis C virus; Hepacivirus; Liver transplantation
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2012.07.061

Abstract Background Recent data from Italian studies have shown excellent results of liver transplantation (LT) in hepatitis B virus (HBV)–infected patients with grafts from hepatitis B core antibody (HBcAb)—positive donors, whereas such grafts in hepatitis C virus (HCV)–infected recipients have displayed poorer outcomes. We investigated the results of LT with HBcAb-positive grafts in patients with ongoing HBV and HCV coinfections. Methods From August 1999 to December 2009, we performed 27 adult primary LTs from deceased heart-beating donors into recipients showing hepatitis B surface antigen (HBsAg)- and HCV-RNA-positivity simultaneously: 12 patients received a graft from an HBsAg-negative HBcAb-positive donor (core+D group) and 15 from an HBcAb-negative donor (core−D group). Immunosuppression included a calcineurin inhibitor, antimetabolite and steroids which were suspended at 6 months. Anti-HBV prophylaxis was always perfomed with anti-HBs immunoglobulins and nucleos(t)idic analogues. Results The groups were similar regarding variables of donor, recipient, donor-recipient match, LT procedure, and acute rejection treatment. Median follow-up for surviving grafts was 67 months (range, 16–141). Among all patients, HCV-RNA remained positive after LT. The prevalence of histologically proven recurrent HCV hepatitis was similar in the 2 groups: 83% core+D vs 73% core−D. No recurrent HBV hepatitis occurred during the follow-up. Graft survival at 5 years was significantly lower in the core+D group (core+D 48% vs core−D 87%; P = .018), in which a significantly higher prevalence of graft loss was caused by HCV recurrence (core+D 5/12, 42% vs core−D 1/15, 7%; P = .03). All of the 5 core+D patients who lost their grafts due to HCV recurrence did not receive anti-HCV therapy (4 owing to an aggressive disease and 1 because of patient refusal). Conclusions Outcomes of LT in patients with ongoing HBV and HCV coinfection are adversely affected by donor HBcAb positivity, an effect that is mainly mediated by the dismal course of HCV recurrence after LT.