The use of Hepatitis B Core Antibody and nucleic acid testing positive organs in safe and effective in Hepatitis B naïve liver transplant recipients

• The utilization of HBV NAT+ organs is a safe and effective strategy in liver transplantation. • Incorporation of these marginal grafts can expand the donor pool. • Treatment with nucleoside reverse transcriptase inhibitors (NRTIs) can help prevent HBV-related complications in marginal graft recipients. • There is no significant difference in patient and graft survival when comparing recipients of HBV NAT+ and HBcAb+ donor organs. Our objective was to examine the outcomes of transplanting Hepatitis B Virus nucleic acid test positive organs (HBV NAT+) and HBcAb+ NAT negative (HBV NAT-) organs into HBV seronegative recipients. We chose to evaluate NAT+ organs since NAT is highly sensitive and specific for viral nucleic acid, amplifying a targeted region of viral ribonucleic acid (RNA) or deoxyribonucleic acid (DNA) and detecting HBV earlier than other screening methods. This study is a retrospective review of patients who were HBV- recipients of HBV NAT+ or HBcAb+ NAT- organs. Primary outcomes include patient and graft survival. Secondary outcomes were manifestations of HBV, including HBV viremia and viral clearance. There were 15 HBV NAT+ recipients and 68 HBcAb+ NAT- recipients who were evaluated for a mean period of 2.6 years and 4.2 years, respectively. Patient survival rates of the HBV NAT+ and HBcAb+ NAT- groups were 92.9%/92.6% at 6 months and 1 year (p=0.97) and 85.7%/90.7% at 3 years (p=0.64). Graft survival rates were 85.7%/92.6% at 6 months and 1 year (p=0.52), and 78.6%/90.7% at 3 years (p=0.33). None of the patient deaths or graft failures were related to HBV. HBV viremia developed in 43%/19% recipients (p=0.12) but viral clearance was observed in 67%/60% patients (p=0.81). There was no statistically significant difference in patient and graft survival when comparing outcomes of HBV NAT+ and HBcAb+ NAT- LT. It is safe to use these grafts for transplantation into HBV- recipients.