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Published on: September 30, 2021
The Matching Status Between Donor and Recipient Hepatitis B Seroepidemiology Makes a Difference in Liver
Di Lu1,2, Fan Yang1,2, Jianyong Zhuo1,2
1Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Insights
Antibody to hepatitis B core antigen (HBcAb) in liver transplant recipients indicates a higher risk of hepatocellular carcinoma (HCC) recurrence. A new nomogram incorporating HBcAb and donor HBsAg status aids in predicting recurrence, improving post-transplant outcomes.
Area of Science:
- Hepatology
- Transplant Surgery
- Oncology
Background:
- Hepatocellular carcinoma (HCC) is a leading cause of liver cancer.
- Liver transplantation is a curative option for select HCC patients.
- Prognostic factors for post-transplant HCC recurrence require further elucidation.
Purpose of the Study:
- To evaluate the prognostic value of antibody to hepatitis B core antigen (HBcAb) and other hepatitis B seroepidemiological markers in HCC transplantation.
- To develop a predictive model for post-transplant HCC recurrence risk.
Main Methods:
- Analysis of a national liver transplant registry data.
- Retrospective study of HCC patients undergoing liver transplantation.
- Development and validation of a risk-predicting nomogram using training and validation cohorts.
Main Results:
- Positive HBcAb in recipients correlated with increased HCC recurrence across various etiologies.
- Donor hepatitis B surface antigen (HbsAg) positivity also associated with recurrence in HBV-related HCC.
- A nomogram integrating recipient HBcAb, donor HBsAg, AFP, and Milan criteria demonstrated strong prognostic capacity.
Conclusions:
- Recipient HBcAb is a significant predictor of post-transplant HCC recurrence.
- The developed nomogram effectively predicts recurrence risk, potentially expanding eligibility for liver transplantation in HCC patients.
Introduction:
Antibody to hepatitis B core antigen (HBcAb) is known to be related with the prognosis for patients with hepatocellular carcinoma (HCC). This study aims to evaluate the prognostic capacity of HbcAb and other donor/recipient hepatitis B seroepidemiological indexes in transplantation for HCC.
Methods:
Based on the national liver transplant registry, we analyzed the prognostic capacity of HBcAb in liver transplantation for patients with HCC of different etiological backgrounds. The hepatitis B virus (HBV)-related HCC cohort was further studied regarding donor/recipient hepatitis B seroepidemiology, and then divided into a training cohort (n = 1,222) and a validation cohort (n = 611) to develop a pretransplant recurrence-risk predicting nomogram.
Results:
Positive HbcAb in recipients was related to an increased risk of post-transplant tumor recurrence in HBV-related (n = 1,833, P = 0.007), HCV-related (n = 79, P = 0.037), and non-B non-C HCC (n = 313, P = 0.017). In HBV-related HCC (n = 1,833), donor hepatitis B surface antigen (HbsAg) was also associated with post-transplant tumor recurrence (P = 0.020). Multivariate analysis showed that the matching status of recipient HbcAb and donor HbsAg (MSHB) was an independent prognostic factor (P = 0.017). HbcAb-positive recipients matched with HbsAg-positive donors displayed the worst post-transplant outcomes (P < 0.001). In the training cohort (n = 1,222), a risk-predicting nomogram was established based on α-fetoprotein, Milan criteria, and MSHB. The model showed excellent prognostic capacity and safely expanded Milan criteria in both training and validation cohorts (P < 0.001).
Discussion:
Positive HbcAb in recipients increases the risk of post-transplant tumor recurrence in HCC with different etiological backgrounds. The nomogram based on MSHB is effective in predicting tumor recurrence after transplantation for HBV-related HCC.
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