Risk Factors of de novo Hepatitis B Virus Infection in Pediatric Hepatitis B Core Antibody Positive Liver Graft Recipients under Prophylactic Therapy

AIMS: To investigate the risk factors of de novo hepatitis B virus (HBV) infection in pediatric liver transplantation recipients receiving hepatitis B core antibody (HBcAb) positive grafts and to evaluate the efficacy of our prophylactic strategies.

METHODS: 139 pediatric recipients receiving HBcAb positive grafts operated from September 2016 to September 2018 were retrospectively enrolled, all the patients received prophylactic treatment to prevent de novo HBV infection. Donor and recipient features, operative information along with graft and recipient outcomes were compared between recipients with or without de novo HBV infection. Univariate and multivariate analysis were applied to identify the risk factors of de novo HBV infection.

RESULTS: The mean follow-up time was 23.5 ± 15.7 months, the overall incidence of de novo HBV infection was 3.6%. Recipients with de novo HBV infection showed equal graft and recipient outcome compared to the recipients without de novo HBV infection during the follow-up time. Recipient pre-operative hepatitis B surface antibody (HBsAb) titer < 1000 IU/L (OR = 9.652, p = 0.024), Graft HBV DNA > 1000 copies (OR = 9.050, p = 0.032) and intra-operative fresh frozen plasma (FFP) transfusion > 400 ml (OR = 10.462, p = 0.023) were identified as independent risk factors for de novo HBV infection.

CONCLUSIONS: HBcAb positive grafts can safely be used in pediatric liver transplantation under rational prophylactic therapy.