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

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

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.

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.