Outcomes of Liver Transplantation in Simultaneously Hepatitis B Surface Antigen and Hepatitis C Virus RNA Positive Recipients: The Deleterious Effect of Donor Hepatitis B Core Antibody Positivity

Background. Recent data from Italian studies have shown excellent results of liver transplantation (LT) in hepatitis B virus (HBV)-infected patients with grafts from hepatitis B core antibody (HBcAb)-positive donors, whereas such grafts in hepatitis C virus (HCV)-infected recipients have displayed poorer outcomes. We investigated the results of LT with HBcAb-positive grafts in patients with ongoing HBV and HCV coinfections. Methods. From August 1999 to December 2009, we performed 27 adult primary LTs from deceased heart-beating donors into recipients showing hepatitis B surface antigen (HBsAg)- and HCV-RNA-positivity simultaneously: 12 patients received a graft from an HBsAg-negative HBcAb-positive donor (core +D group) and 15 from an HBcAb-negative donor (core -D group). Immunosuppression included a calcineurin inhibitor, antimetabolite and steroids which were suspended at 6 months. Anti-HBV prophylaxis was always perfomed with anti-HBs immunoglobulins and nucleos(t)idic analogues. Results. The groups were similar regarding variables of donor, recipient, donor-recipient match, LT procedure, and acute rejection treatment. Median follow-up for surviving grafts was 67 months (range, 16-141). Among all patients, HCV-RNA remained positive after LT. The prevalence of histologically proven recurrent HCV hepatitis was similar in the 2 groups: 83% core +D vs 73% core -D. No recurrent HBV hepatitis occurred during the follow-up. Graft survival at 5 years was significantly lower in the core +D group (core +D 48% vs core -D 87%; P = .018), in which a significantly higher prevalence of graft loss was caused by HCV recurrence (core +D 5/12, 42% vs core -D 1/15, 7%; P = .03). All of the 5 core +D patients who lost their grafts due to HCV recurrence did not receive anti-HCV therapy (4 owing to an aggressive disease and 1 because of patient refusal). Conclusions. Outcomes of LT in patients with ongoing HBV and HCV coinfection are adversely affected by donor HBcAb positivity, an effect that is mainly mediated by the dismal course of HCV recurrence after LT.