The use of Hepatitis B Core Antibody and nucleic acid testing positive organs in safe and effective in Hepatitis B naïve liver transplant recipients

Abstract

Our objective was to examine the outcomes of transplanting Hepatitis B Virus nucleic acid test positive organs (HBV NAT+) and HBcAb+ NAT negative (HBV NAT-) organs into HBV seronegative(HBV-) recipients. We chose to evaluate NAT+ organs since NAT is highly sensitive and specific for viral nucleic acid, amplifying a targeted region of viral ribonucleic acid (RNA) or deoxyribonucleic acid (DNA) and detecting HBV earlier than other screening methods. This study is a retrospective review of patients who were HBV- recipients of HBV NAT+ or HBcAb+ NAT- organs. Primary outcomes include patient and graft survival. Secondary outcomes were manifestations of HBV, including HBV viremia and viral clearance. There were 15 HBV NAT+ recipients and 68 HBcAb+ NAT- recipients who were evaluated for a mean period of 2.6 years and 4.2 years, respectively. Patient survival rates of the HBV NAT+ and HBcAb+ NAT- groups were 92.9 %/92.6 % at 6 months and 1 year (p = 0.97) and 85.7 %/90.7 % at 3 years (p = 0.64). Graft survival rates were 85.7 %/92.6 % at 6 months and 1 year (p = 0.52), and 78.6 %/90.7 % at 3 years (p = 0.33). None of the patient deaths or graft failures were related to HBV. HBV viremia developed in 43 %/19 % recipients (p = 0.12) but viral clearance was observed in 67 %/60 % patients (p = 0.81). There was no statistically significant difference in patient and graft survival when comparing outcomes of HBV NAT+ and HBcAb+ NAT- LT. It may be safe to use these grafts for transplantation into HBV- recipients.