Utilization of HBV Surface Antigen Positive Grafts in Liver Transplantation: A Matched Study Based on a National Registry Cohort

Abstract Background and purposeDonor shortage has become worldwide limitation in liver transplantation. Use of HBsAg+ donors could be an alternative source of donor organs. This study aims to prove the safety and efficacy of liver transplantation using HBsAg+ liver grafts and its long-term outcome.MethodsThis was a retrospective study of adults liver transplantation registered in the database of the China Liver Transplant Registry between January 2015 and September 2018. By propensity score matching (1:1), 503 eligible patients who received HBsAg+ liver grafts were compared with 503 matched patients who received HBsAg- liver grafts.ResultsThe 1-, 3- and 4-year patient survival rates were 81.52%, 72.04% and 70.03% in HBsAg+ donor group, that were comparable to 83.93%, 77.27% and 75.52% in HBsAg- donor group (p=0.222). The 1-, 3- and 4-year graft survival rates were also comparable between the two groups (81.49%, 71.45% and 70.24% vs. 83.62%, 77.11% and 75.32%, respectively, p=0.243). Most main complications were not increased in HBsAg+ donor group except for the retaining of HBsAg positivity after liver transplantation. Furthermore, transplanting HBsAg+ liver grafts did not result in inferior outcomes either in HBsAg+ or HBsAg- recipients. The risk of tumor recurrence after liver transplantation was neither increased in hepatocellular carcinoma patients. ConclusionsThe outcomes of using HBsAg+ liver grafts were comparable with those of HBsAg- liver grafts. Our study provided strong evidence for the safe use of HBsAg+ grafts to expand the donor liver pool.