Hepatitis B surface antigen positive donors for liver recipients with hepatocellular carcinoma: a single centre experience

Introduction Due to the severe shortage of the donor pool, the use of hepatitis B surface antigen-positive donors is a possible strategy to increase the donor pool, but there are few data about the outcomes in liver recipients with hepatocellular carcinoma (HCC) and their recurrence rate. Aim The aim of this study is to evaluate the impact of HBsAg poisitive donors in liver recipients transplanted for HCC Methods Patients undergoing liver transplantation (LT) between January, 2004, and November 2022, were retrospectively evaluated. 17 patients (1,5%) with HCC, received the graft from hepatitis B surface antigen positive (HBsAg)-positive deceased donors Results All patients were male and Milan IN. Median time of follow up was 63±5 months. Median MELD was 16. Seven (41%) recipients had not an HBV-related liver disease. Only one patient before LT had hepatitis B surface antibody. Three patients had an HBV/HDV cirrhosis. In all recipients HBV DNA was suppressed at the time of LT. Eight (47%) patients did a prophylaxis with HBV-specific immunoglobulins after LT.At 1 – 3 and 5 year in all the recipients, hepatitis B surface antigen positivity was recorded. Only one patient developed hepatitis B surface antibodies but was immunized before LT.HBV DNA was detected in one patient at 1 and 3 years, but they were responsive to antiviral treatment. Only one patient had HCC recurrence. Overall survival at 1-3 and 5 year was 76,5%. Conclusions We suggest that the use of HBsAg positive donors is safe and in our cohort of HCC transplanted patients, only one experienced HCC recurrence. Moreover, it would be fundamental to immunize all patients before LT.