Hepatitis B virus reactivation in hepatitis B core antibody positive lung transplant recipients

Abstract

BackgroundSolid organ transplant recipients with resolved hepatitis B (HBV) infection are at risk for reactivation, however, most of the studies have focused on kidney transplant recipients and have short to intermediate term follow up. Risk factors for reactivation are also uncertain, with some studies suggesting surface antibody (anti-HBs) may be protective. MethodsThis retrospective single center study aimed to assess the risk of HBV reactivation (HBVr) in lung transplant recipients with prior HBV infection as well as the value of anti-HBs titers in predicting HBVr. Surface antigen (HBsAg) negative, core antibody (anti-HBc) positive adult lung and heart-lung SOTR from 2005 to 2019 were included. The primary outcome was HBVr after transplant, defined as seroreversion to HBsAg positivity. The secondary outcome compared anti-HBs titers at transplant and at posttransplant month 12. ResultsThe cohort included 38 lung and heart-lung recipients with anti-HBc positive, HBsAg negative pretransplant serology. Reactivation occurred in 3 of 38 (8%) at 49, 69 and 94 months posttransplant. Two (5% of cohort) subjects died as a consequence of HBVr. Two of the 3 HBVr patients had anti-HBs titers >10 IU/ml at transplant and one had anti-HBs >100 IU/ml at time of HBV reactivation. We did not find a statistically significant decrease in anti-HBs titers one year after transplant in subjects with baseline anti-HBs>10 IU/ml. ConclusionThe prolonged time to reactivation highlights the lifelong risk. The 8% rate of reactivation and 5% mortality support a preferred strategy of indefinite HBV antiviral prophylaxis over monitoring in anti-HBc positive lung recipients.