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Expanding the Donor Pool for Liver Transplantation: Assessing the Potential Use of HBV-Positive Allografts

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Abstract

Purpose of Review

This review summarizes the feasibility, benefits, and concerns of utilizing hepatitis B virus (HBV)-positive allografts for liver transplant.

Recent Findings

Analyses of registry-based and multi-center cohorts, in this current era of high-barrier nucleos(t)ide analogue therapies, have shown that recipients of HBV-positive allografts have long-term graft and recipient rates comparable to recipients of HBV-negative allografts. The utilization of HBV-positive allografts can also be cost-effective. However, early evidence indicates that for recipients with hepatocellular carcinoma (HCC), the utilization of HBV-positive allografts may increase the risk of recurrent HCC and mortality.

Summary

Although HBV-positive allografts have the potential to expand the organ pool and shorten candidate waitlist times and mortality, certain recipient subgroups including those with HCC require closer attention and additional data. There are also important economic and ethical issues surrounding informed consent, equity, society stigma, and transparency to consider.

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Abbreviations

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

OLT:

Orthotopic liver transplant

HCV:

Hepatitis C virus

Anti-HBc:

Hepatitis B core IgG antibody

HBsAg:

Hepatitis B surface antigen

HBsAb:

Hepatitis B surface IgG antibody

HBIG:

Hepatitis B virus immune globulin

NA:

Nucleos(t)ide analogues

NAT:

Nucleic acid testing

OPTN:

Organ Procurement and Transplantation Network

CLTR:

China Liver Transplant Registry

ETV:

Entecavir

TDF:

Tenofovir disproxil fumarate

TAF:

Tenofovir alafenamide

HDV:

Hepatitis delta virus

MELD:

Model for End-Stage Liver Disease

QALY:

Quality-adjusted life year

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of Washington Medical Center, 1959 NE Pacific Street, Box 356175, Seattle, WA, 98195-6175, USA

    Philip Vutien

  2. Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA

    Mindie H. Nguyen

  3. Department of Epidemiology and Population Health, Stanford University Medical Center, Palo Alto, CA, USA

    Mindie H. Nguyen

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  1. Philip Vutien
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PV and MHN prepared the manuscript text, table, and figure.

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Vutien, P., Nguyen, M.H. Expanding the Donor Pool for Liver Transplantation: Assessing the Potential Use of HBV-Positive Allografts. Curr Hepatology Rep 23, 227–240 (2024). https://doi.org/10.1007/s11901-024-00653-8

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