Liver transplantation from hepatitis B surface antigen positive donors: A safe way to expand the donor pool

Loggi, Elisabetta; Micco, L.; Ercolani, Giorgio; Cucchetti, Alessandro; Bihl, Florian; Grazi, Gian Luca; Gitto, Stefano; Bontadini, Andrea; Bernardi, Mauro; Grossi, Paolo; Costa, Alessandro Nanni; Pinna, Antonio Daniele; Berthou, Christian; Andreone, Pietro

doi:10.1016/j.jhep.2011.09.016

Cited by 65 publications

(56 citation statements)

References 21 publications

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“…However these may be used in life threatening situations such as ALF or HBV related HCC where delay may make these cases untransplantable. Two small retrospective studies have reported the safe use of HBsAg positive liver grafts in patients with HBV related CLD [46] and HBV unrelated CLD [47] with satisfactory results. Both groups have suggested that long-term HBIG prophylaxis may not be effective and advised institution of double anti-viral therapy as prophylaxis.…”

Section: Hepatitis B Virusmentioning

confidence: 99%

Matching donor to recipient in liver transplantation: Relevance in clinical practice

Reddy¹,

Varghese²,

Venkataraman³

et al. 2013

WJH

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Achieving optimum outcomes after liver transplantation requires an understanding of the interaction between donor, graft and recipient factors. Within the cohort of patients waiting for a transplant, better matching of the donor organ to the recipient will improve transplant outcomes and benefit the overall waiting list by minimizing graft failure and need for re-transplantation. A PubMed search was conducted to identify published literature investigating the effects of donor factors such as age, gender, ethnicity, viral serology; graft factors such as size and quality, recipient factors such as age, size, gender and transplant factors such as major or minor blood group incompatibility and immunological factors. We also report technical and therapeutic modifications that can be used to manage donor-recipient mismatch identified from literature and the authors' clinical experience. Multiple donor and recipient factors impact graft survival after liver transplantation. Appropriate matching based on donor-organ-recipient variables, modification of surgical technique and innovative peri-transplant strategies can increase the donor pool by utilizing grafts from marginal donors that are traditionally turned down.

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Section: Hepatitis B Virusmentioning

confidence: 99%

Matching donor to recipient in liver transplantation: Relevance in clinical practice

Reddy¹,

Varghese²,

Venkataraman³

et al. 2013

WJH

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“…Several reports document that livers procured from HCV+ donors that have minimal histological evidence of fibrosis achieve similar results when transplanted into HCV-positive recipients compared with HCV-livers used to transplant HCV-positive recipients [42,43]. Similar results have been achieved using HBV-positive donors for HBV-positive recipients [44] and there is mounting evidence that anti-HBc-positive, HBsAg-negative livers used for HBV na€ ıve recipients can achieve good results when suitable HBV prophylactic treatment is provided [45].…”

Section: Hcv and Other Donor Infectionsmentioning

confidence: 82%

Deceased donor risk factors influencing liver transplant outcome

Freeman

2013

Transpl Int

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SummaryAs the pressure for providing liver transplantation to more and more candidates increases, transplant programs have begun to consider deceased donor characteristics that were previously considered unacceptable. With this trend, attention has focused on better defining those donor factors that can impact the outcome of liver transplantation. This review examines deceased donor factors that have been associated with patient or graft survival as well as delayed graft function and other liver transplant results.In the early development of liver transplantation, clinicians were very conservative in selecting what was thought to be donor livers that were most likely to function well. This was driven partially by the fact that patient selection and transplant surgery themselves were not well understood. Both factors contribute significant uncertainty to the outcome of the transplant so liver teams did not want to introduce more uncertainty by using donor organs that were thought to carry additional risks. However, as much more evidence for selecting appropriate candidates has accumulated and the surgical procedure has become more standardized and routine, along with an increasing demand for transplantation, attention has been directed toward understanding a broader range of donor factors that can influence the outcome of liver transplantation.Over the last several years, numerous investigators have identified many liver donor factors that are important contributors to patient outcome. These studies have been facilitated by the existence of much more robust databases in which donor and recipient variables are collected for outcome analyses. In the following sections, five main categories of donor factors will be reviewed; donor demographics, donor diseases, donor cause of death and mechanism of death, donor allocation factors, and composite scores. For simplicity, this paper will address only deceased donors and focuses mostly on the donor risks themselves, recognizing that it is the combination of donor risks, recipient factors, and many other details that ultimately determine the success or failure of a given liver transplant procedure. Demographics Donor ageThere is a large body of evidence dating back more than 20 years documenting that the age of the donor is an independent risk factor for both liver transplant graft and

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“…To further expand the available donor pool, the focus recently shifted towards a greater use of HBsAg-positive liver grafts from donors with overt HBV infection, but with normal graft morphology and liver function. Current experiences with these high-risk ECD allografts are still limited, particularly because allocation of HBsAg+ liver grafts is rejected in many transplant centers [104][105][106][107][108][109][110][111][112][113] . Therefore, the prognostic value of HBIg and its immunomodulatory efficacies in this special transplant setting is still undefined.…”

Section: Antiviral Prophylaxis Impact Of Hbig On Outcomementioning

confidence: 99%

Intravenous immunoglobulins in liver transplant patients: Perspectives of clinical immune modulation

Kornberg¹

2015

WJH

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Liver transplantation from hepatitis B surface antigen positive donors: A safe way to expand the donor pool

Cited by 65 publications

References 21 publications

Matching donor to recipient in liver transplantation: Relevance in clinical practice

Matching donor to recipient in liver transplantation: Relevance in clinical practice

Deceased donor risk factors influencing liver transplant outcome

Intravenous immunoglobulins in liver transplant patients: Perspectives of clinical immune modulation

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