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초록

Background: In the era of nucleoside analogs (NA), we investigated the safety of using hepatitis B surface antigen (HBsAg)-positive grafts in liver transplantation (LT) using nationwide KOTRY data. Methods: Among 4,265 adult LTs in the KOTRY registry (April 2014–January 2020), 20 (0.5%) used HBsAg(+) grafts. The S(+) group was compared with HBsAg-negative groups, both HBcAb(+) (C[+]) and HBcAb(−) (SC[−]), using 1:1 propensity score matching. Patient and graft survival were evaluated using Kaplan–Meier analysis. Cox regression was used to identify prognostic factors. Results: No significant differences were observed in patient or graft survival between S (+) and C (+) or S C(−) groups. Key prognostic factors for patient survival included age, HCC, MELD score, ascites, and encephalopathy. For graft survival, HCC, preoperative HCC treatment, MELD score, ascites, and encephalopathy were significant. HBV recurrence occurred in the S(+) group, but did not compromise outcomes. Conclusion: In HBV-endemic regions, HBsAg(+) liver grafts can be safely used to expand the donor pool without compromising LT outcomes when combined with appropriate prophylaxis.

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