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Oral Presentations

Session Title: Parallel Session: LIVER TRANSPLANTATION
Presentation Date: 31 MAR, 2011

THE CURRENT ALLOCATION POLICY OF LIVER GRAFTS FROM HBCAB POSITIVE DONORS NEEDS TO BE IMPROVED: EVIDENCE FROM THE LIVER-MATCH COHORT STUDY

M. Angelico¹*, T. Marianelli¹, U. Cillo², S. Fagiuoli³, D. Prati⁴, C. Gavrila⁵, A. Nardi⁵, And The Liver Match Study Group
¹Gastroenterology, Tor Vergata University, Rome, ²Surgery, University of Padova, Padova, ³Gastroenterology, Ospedali Riuniti, Bergamo, ⁴Ospedale di Lecco, Lecco, ⁵Mathematics, Tor Vergata University, Roma, Italy. *angelico@med.uniroma2.it

In the current donor shortage era the optimal use of HBcAb+ve donor grafts is mandatory, yet current recommendations are not supported by evidence-based data. We evaluated the survival of grafts from HBcAb+ve donors within Liver Match, a prospective observational study on Liver Transplantation (LT) in Italy.
Methods: Data from 1477 consecutive non-urgent first adult LT from June 2007 to May 2009 were analyzed by Kaplan Meier and Cox regression in relation to donor and recipient factors, including HBcAb and HBsAb.
Results: There were 1237 HBcAb negative and 240 (16.3%) HBcAb positive donors, with unadjusted two-year graft survival of 0.80 (s.e. 0.014) and 0.69 (s.e. 0.033), respectively (log-rank, p= 0.0004). HBcAb positive donor grafts were allocated to 120 anti-HCV positive, 53 non-HBV/non-HCV and 67 HBsAg positive recipients, whose two-year graft survival was 0.61 (s.e. 0.051), 0.66 (s.e. 0.067) and 0.85 (s.e. 0.047), respectively (log-rank, p= 0.001). Notably, in the same period 213 transplants were performed in HBsAg positive recipients using HBcAb negative donor grafts. Two-year survival was 0.79 (s.e. 0.019) among 651 LT HBcAb negative both in donors and recipients; 0.81 (s.e. 0.019) among 586 with HBcAb negative donors but positive recipients; 0.68 (s.e. 0.051) among 89 with HBcAb positive donors but negative recipients; and 0.68 (s.e. 0.045) among 151 with HBcAb positive both in donors and recipients (log-rank, p=0.0023). Recipient HBsAb positivity was not associated with better survival, regardless of HBcAb status. Cox regression identified the following graft loss predictors: HBcAb+ve donor (HR 1.71, 1.29-2.27), Donor Risk Index (HR 1.66 per unit, 1.17-2.37, MELD at transplant (HR: 1.44 per 10 units, 1.24-1.68), and HCV- and non-HBV/non-HCV-related vs HBV-related disease (HR 2.02, 1.37-3.00; and 1.94, 1.28-2.93). No graft loss was due to overt HBV recurrence.
Conclusion: This prospective cohort study shows that HBcAb positive donor grafts have excellent outcomes when allocated to HBsAg positive recipients but worse outcomes when given to all categories of HBsAg negative recipients, regardless of their HBcAb/HBsAb status. This is unlikely due to insufficient HBV prophylaxis, as graft loss was unrelated to HBV recurrence. These findings have major relevance for organ allocation policies in Mediterranean countries.