Author information

• ¹School of Medicine, Baylor College of Medicine, Houston, Texas, USA.
• ²Memorial Hermann Hospital The Woodlands, Spring, Texas, USA.
• ³Department of Medicine, State University of New York (SUNY) Downstate, Health Sciences University, Brooklyn, New York, USA.
• ⁴Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut.
• ⁵Department of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA.
• ⁶Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
• ⁷Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
• ⁸Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA; Michael E DeBakey VA Medical Center, Houston, TX, USA.
• ⁹Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA; Division of Abdominal Transplantation, Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
• ¹⁰Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA; Division of Abdominal Transplantation, Department of Surgery, Baylor College of Medicine, Houston, Texas, USA. Electronic address: tzu-hao.Lee@bcm.edu.

Abstract

Livers from donors with positive hepatitis B surface antigens (HBsAg+) have been used to expand the donor pool; however, outcome data are limited. We aim to evaluate survival following liver transplant (LT) from HBsAg+ donors. Using the United Network for Organ Sharing registry, we identified HBsAg+ donors used for LT from 2009 to 2020. We used Kaplan-Meier survival and Cox proportional hazards regression to compare post-LT survival in hepatitis B virus-negative recipients who utilized HBsAg+ donors to propensity-matched cohorts who utilized other types of donors. From 2009-2020, 70 patients received HBsAg+ livers, and 58 of them did not carry a diagnosis of chronic hepatitis B virus. The 1- and 3-year post-LT survival for hepatitis B virus-negative patients who received livers from HBsAg+ donors were 96.6% and 91.4%, respectively, with no statistical differences compared with patients who received livers from hepatitis C virus viremic donors (96.5%/93.0%, P = .961/.427), donation after cardiac death donors (93.0%/86.0%, P = .651/.598), average-risk donors (89.5%/86.0%, P = 0.264/0.617), and a combination of extended-criteria donors, including donation after cardiac death, donor age over 70, and graft with greater than 30% steatosis (93.0%/91.2%, P = .621/.785). Recipients of HBsAg+ livers have similar post-LT survival compared with those receiving other types of grafts. Increasing the utilization of HBsAg+ livers could safely expand the donor pool.