Editorial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2017; 23(12): 2095-2105
Published online Mar 28, 2017. doi: 10.3748/wjg.v23.i12.2095
Long term follow-up and outcome of liver transplantation from hepatitis B surface antigen positive donors
Roberto Ballarin, Alessandro Cucchetti, Francesco Paolo Russo, Paolo Magistri, Matteo Cescon, Umberto Cillo, Patrizia Burra, Antonio Daniele Pinna, Fabrizio Di Benedetto
Roberto Ballarin, Paolo Magistri, Fabrizio Di Benedetto, Hepatopancreatobiliary Surgery and Liver Transplant Unit, University Hospital “Policlinico”, University of Modena and Reggio Emilia, 41124 Modena, Italy
Alessandro Cucchetti, Matteo Cescon, Antonio Daniele Pinna, Department of Medical and Surgical Sciences, DIMEC, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
Francesco Paolo Russo, Umberto Cillo, Patrizia Burra, Gastroenterology/Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, 35128 Padua, Italy
Paolo Magistri, Department of Medical and Surgical Sciences and Translational Medicine, Sapienza, University of Rome, 00185 Rome, Italy
Author contributions: Ballarin R designed the research; Ballarin R, Cucchetti A, Russo FP and Burra P performed the research; Ballarin R, Cucchetti A, Russo FP, Burra P and Magistri P analyzed the data; Ballarin R and Magistri P wrote the paper; Cillo U, Pinna AD and Di Benedetto F critically revised the manuscript; all the authors contributed to this manuscript.
Conflict-of-interest statement: None of the authors has conflict of interest related to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Roberto Ballarin, MD, PhD, Hepatopancreatobiliary Surgery and Liver Transplant Unit, University Hospital “Policlinico”, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy. ballarinroberto@hotmail.com
Telephone: +39-59-4224740
Received: August 19, 2016
Peer-review started: August 19, 2016
First decision: September 20, 2016
Revised: January 30, 2017
Accepted: March 2, 2017
Article in press: March 2, 2017
Published online: March 28, 2017
Processing time: 221 Days and 4.7 Hours
Abstract

Liver transplant for hepatitis B virus (HBV) currently yields excellent outcomes: it allows to rescue patients with an HBV-related advanced liver disease, resulting in a demographical modification of the waiting list for liver transplant. In an age of patient-tailored treatments, in liver transplantation as well the aim is to offer the best suitable graft to the patient who can benefit from it, also expanding the criteria for organ acceptance and allocation. With the intent of developing strategies to increase the donor pool, we set-up a multicenter study involving 3 Liver Transplant Centers in Italy: patients undergoing liver transplantation between March 03, 2004, and May 21, 2010, were retrospectively evaluated. 1408 patients underwent liver transplantation during the study period, 28 (2%) received the graft from hepatitis B surface antigen positive (HBsAg)-positive deceased donors. The average follow-up after liver transplantation was 63.7 mo [range: 0.1-119.4; SD ± 35.8]. None Primary non-function, re-liver transplantation, early or late hepatic artery thrombosis occurred. The 1-, 3- and 5-year graft and patient survival resulted of 85.7%, 82.1%, 78.4%. Our results suggest that the use of HBsAg-positive donors liver grafts is feasible, since HBV can be controlled without affecting graft stability. However, the selection of grafts and the postoperative antiviral therapy should be managed appropriately.

Keywords: Liver transplantation; Hepatitis B virus; Hepatitis B surface antigen; Hepatocellular carcinoma; Organ allocation; Organ procurement; Multicenter study

Core tip: With the intent of developing strategies to increase the donor pool, we set-up a multicenter study involving 3 Liver Transplant Centers in Italy between March 2004 and May 2010. 1408 patients underwent liver transplantation during the study period, and 28 received the graft from hepatitis B surface antigen positive (HBsAg)-positive deceased donors. None primary non-function, re-liver transplantation, early or late hepatic artery thrombosis occurred. Our results show that transplantation of grafts from deceased HBsAg positive donors is feasible and this represents a way to expand the donor pool, especially in the high-endemic areas where a large proportion of patients are highly viremic and HBeAg positive.