INFO: Hepatitis-Positive Livers Are Safe to Use in Hepatitis-Positive Transplant Recipients

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Hepatitis-Positive Livers Are Safe to Use in Hepatitis-Positive Transplant Recipients

Schorr

May 26, 2005 (Seattle) — Liver transplant recipients currently infected with either hepatitis C or previously with hepatitis B do not have to wait for a hepatitis-negative donor organ, but may have equally good outcomes using a hepatitis-positive organ, according to research presented here at the American Transplant Congress 2005: 6th Annual Joint Meeting of the American Society of Transplant Surgeons and the American Society of Transplantation.

While the practice of using livers from hepatitis-positive donors is fairly well accepted, there are still some centers that decline the organs for hepatitis-positive patients in favor of hepatitis-free organs. However, these findings should encourage them to reconsider the use of hepatitis-infected organs on corresponding patients.

"This is a pool of organs we can safely use," lead author E. de Vera, MD, an assistant professor of surgery at the University of Pittsburgh in Pennsylvania, told Medscape. "When used appropriately, it is safe, the outcomes are good, and it increases the number of available organs."

de Vera said his center conducted around 1,100 total liver transplants during the time of the study, and about 100 were from donors with either hepatitis C or hepatitis B core–positive antibodies.

The study compared outcomes for hepatitis-positive patients who received these livers with patients who received livers with no hepatitis infection and found that patients fared just as well whether they received a hepatitis-positive or hepatitis-negative donor organ.

"We found these patients did just as well, and the patient and graft survival were the same," de Vera noted. "Hepatitis should not preclude patients from being organ donors."

The study also looked at the outcomes of liver transplant recipients of hepatitis C-positive livers, hepatitis B core–positive antibodies, and those positive with both agents between 1997 and 2004. There were 28 transplanted livers positive for both viruses, 58 positive for hepatitis B core–positive antibodies, and 34 positive for hepatitis C.

All of the transplant recipients received the same immunosuppression therapy of either tacrolimus or cyclosporine and steroids. Those receiving livers from hepatitis B–positive antibody donors also received hepatitis B immune globulin and/or the antiretroviral drug lamivudine. The recipients were similar in age, sex, and Model for End-Stage Liver Disease scores of disease severity.

The patient survival rates after an average of two years was 68% for those receiving livers with both viruses, 76% for those receiving livers with the hepatitis B antibodies, and 82% for those receiving livers with hepatitis C. Graft survival rates were 64%, 65%, and 76%, respectively.

The donor livers with hepatitis C were used only in patients already infected with hepatitis C, as the reinfection rate is 100%, de Vera said. However, these patients did just as well as those with hepatitis C who were given a hepatitis-negative liver.

"If a patient has hepatitis C, it does not matter if they receive a hepatitis-positive or hepatitis-negative liver," de Vera said. "The outcomes are the same," Dr. de Vera speculated that if the donated organ carries a less aggressive version of the hepatitis C virus, the patient could actually be better off.

The livers with hepatitis B–positive antibodies were transplanted into recipients who previously were exposed either to hepatitis B, had current infections, were immune via vaccination, or occasionally were uninfected patients in cases of extreme emergency.

Only 4.6% of the patients who received the hepatitis B antibody–positive organs seroconverted, despite preventive medicine. However, de Vera pointed out that hepatitis B is "easily controlled with antiviral drugs, and even if it comes back, it is very mild."

"This is a useful study; the long-term outcome is good," Michele Alonzo, MD, research coordinator for the transplant group at the University of Cincinnati Medical Center in Cincinnati, Ohio, who was unaffiliated with the research, told Medscape. "It is a good tool to prove to patients that we can use these organs, and your waiting time can be shortened. There is more risk (of developing hepatitis , but most patients are willing to accept that risk."

The investigators had no financial disclosures.

ATC 2005: 6th Annual Joint Meeting of the American Society of Transplant Surgeons and the American Society of Transplantation: Abstract 1138. Presented May 24, 2005.

Reviewed by D. Vogin, MD