Abstract
BackgroundIn order to reduce the burden on organ shortage around the world, using potential infectious donor might be an option. However, scarce evidences have been published on kidney transplantation (KTx) from hepatitis B surface antigen (HBsAg) + donors to HBsAg- recipients [D (HBsAg+)/R(HBsAg-)] without hepatitis B virus (HBV) immunity. Here, we reported the results of D(HBsAg+/HBV DNA- or +)/R(HBsAg-) living KTx recipients with or without HBV immunity.MethodsWe retrospectively identified 83 D(HBsAg+)/R(HBsAg-) living KTx recipients, and 83 hepatitis B core antibody (HBcAb) + living donors to HBcAb- recipients [D(HBcAb+)/R(HBcAb-)] were used as control group by reviewing medical archives and propensity score matching. Treatment failure (defined as any HBV serology conversion, liver injury, graft loss, or recipient death) is the primary endpoint.ResultsTwenty-four donors (28.9%) were HBV DNA+, and 20 recipients had no HBV immunity in the D(HBsAg+)/R(HBsAg-) group pre-transplantation. HBV prophylaxis was applied in all D(HBsAg+)/R(HBsAg-) recipients, while none was applied in the D(HBcAb+)/R(HBcAb-) group. We observed a significant higher treatment failure in D(HBsAg+)/R(HBsAg-) than D(HBcAb+)/R(HBcAb-) group (21.7% vs. 10.8%, P < 0.001). Interestingly, no significant difference was found between groups on HBV seroconversion, liver and graft function, rejection, infection, graft loss, or death. However, 2/20 recipients without HBV immunity in the D(HBsAg+)/R(HBsAg-) group developed HBV DNA+ or HBsAg+, while none observed in the D(HBcAb+)/R(HBcAb-) group. HBV DNA+ donor and male recipient were significant risk factors for treatment failure.ConclusionD(HBsAg+)/R(HBsAg-) should be considered for living kidney transplantation, but with extra caution on donors with HBV DNA+ and male candidates.
Highlights
In order to reduce the burden on organ shortage around the world, using potential infectious donor might be an option
We found that the liver and graft function, rejection rate, infection, and graft loss were comparable between D(HBsAg+)/R(HBsAg-) and D(HBcAb+)/R(HBcAb-) groups, except recipient deaths were more frequent in the D(HBsAg+)/R(HBsAg-) group
We reviewed donors and recipients’ electronic medical records and extracted the donor/recipient demographics, end stage renal failure causes, prior transplant history, immunological features, induction, and immunosuppression regimens et al hepatitis B virus (HBV)-associated parameters such as pre- and post-transplant status of hepatitis B surface antigen (HBsAg), hepatitis B surface antibody positive (HBsAb), hepatitis B e antigen (HBeAg), hepatitis B e antibody (HBeAb), hepatitis B core antibody (HBcAb), HBV DNA, peri-surgical treatment including application of hepatitis B immunoglobulin (HBIG) and antiviral prophylaxis, and liver function were recorded upon every visit
Summary
In order to reduce the burden on organ shortage around the world, using potential infectious donor might be an option. As the demand of organ transplantation continues to increase in the past decades, more and more medical facilities are facing serious issues including organ shortage [1,2,3] This is always of great concern among transplant clinicians over the years, and it pushed the transplant centers to expand the criteria of accepting donors, including older age of 70 to 80, with significant medical history, with abnormal social behavior, or a concurrent history of hepatitis B or C virus exposure [4,5,6,7,8]. As reported by the World Health Organization in 2019, 257 million people were living with chronic hepatitis B virus (HBV) infection, defined by hepatitis B surface antigen positive (HBsAg+). The previous clinical practices on HBsAg+ donors were limited to HBsAg+ recipients which restricted their great use [11]
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