Abstract
Introduction: There is variation of practice amongst UK kidney and pancreas transplant units in implanting grafts from HBcAb +ve donors due to the perceived risk of transmission of hepatitis B (HBV). Centres transplanting such grafts have variable practice of antiviral prophylaxis with lamivudine ranging from no prophylaxis to life-long prophylaxis. The aim of this study was to assess the rate of HBV infection in HBsAg -ve recipients of renal and pancreas allografts receiving organs from HBcAb +ve, HBsAg -ve donors. Methods: We surveyed the UK kidney and pancreas transplant units regarding their practices of accepting HBcAb +ve donor grafts and the subsequent use of antiviral prophylaxis. All patients receiving a kidney (KT) and or pancreas (PT) allograft from HBcAb +ve, HBsAg -ve donors between Jan 2002 and Dec 2011 were identified retrospectively from the UK Transplant Registry. Post transplant virology data were also collected. All patients had a minimum follow-up of 2 years. Results: The survey was incomplete at the time of this analysis and hence is not presented. A total of 277 patients were identified who underwent KT (n=252) or PT (n=25) from HBcAb +ve donors. Of these 2 KT recipients were HBsAg +ve prior to transplantation and were excluded from the analysis. Of the remaining 275, seven recipients (6 KT, 1 PT) had documented evidence of HBV positive virology post transplant (2.5%). At the time of this analysis, 178 patients (159 KT, 19 PT) had documented negative virology (65%) and 98 (93 KT and 5 PT) were recorded as ‘not reported’ (35%). Of the 11 KT in our centre, no HBV transmission recorded. All received 100 day lamivudine prophylaxisConclusions: The risk of HBV transmission following kidney and pancreas transplantation from HBcAb +ve donors remains low. Use of antiviral prophylaxis can help reduce this risk further. We suggest 100-day post-transplant lamivudine prophylaxis in kidney and pancreas transplantation. There is a need for clear guidelines for the safe and effective use of HBcAb +ve grafts
Published Version
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