Renal transplantationOutcomeKidney Transplantation From Hepatitis B Surface Antigen–Positive Donors Into Hepatitis B Surface Antigen–Positive Recipients: Preliminary Findings
Section snippets
Patients and methods
From January 2002 to March 2004, 5 patients with end-stage renal disease, HBV infection, and HbsAg seropositivity, after informed consent, underwent a kidney transplantation from a cadaveric HbsAg-positive donor (D+/R+).
All patients with pretransplantation HBV-DNA+ had undergone a liver biopsy. Exclusion criteria were considered a compromised liver functionality and a high serum level of aspartate aminotransferase (AST)/alanine aminotransferase (ALT) at the time of transplantation.
Results
There was 3 male and 2 female recipients, with a median age of 46.5 years (range, 42–55 years). The median time on the waiting list was 8 months. One donor had HbsAg/HbeAg positivity. One patient experienced an acute rejection that was successfully treated with a bolus of steroids. One patient showed an increase in serum level of AST/ALT 2 months after transplantation, which completely resolved in 1 month.
Graft and patient survival rates at a median follow-up of 12 months are both 100%.
Discussion
The chronic shortage of organ donors have stimulated the interest in transplanting organs formerly considered marginal or undesiderable.
The high prevalence of HBV infection in some endemic areas has stimulated the use of HbsAg-positive donors for transplantation. In these areas, in fact, there is often a correspondingly high prevalence of naturally acquired immunity to HBV among the renal transplant candidates, which makes it relatively easy to find patients immune to HBV.
A few small studies
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Kidney transplantation from hepatitis B surface antigen (HbsAg)-positive donorschange of relative HBV genomic copy number after transplantation
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Cited by (14)
Hepatitis Viruses in Kidney Transplantation
2016, Seminars in NephrologyCitation Excerpt :Thus, D+/R+ transplantation should be the last resort at this time. Nevertheless, the use of HBsAg+ donors can reduce the waiting time on the transplant list significantly.24 Renal transplantation from donors with active HBV infection is contraindicated if the recipient is HBV naive.
Hepatitis B virus and renal transplantation
2011, Transplantation ReviewsCitation Excerpt :In the setting of negative HBeAg status, the presence of a precore mutant should be excluded by checking the presence of DNA in serum [62]. Several studies [63-69] have reported the use of HBsAg-positive donors to HBsAg-positive recipients or to patients who are immune to HBV; the risk remains controversial. In efforts to expand the donor pool, Akalin and colleagues [70] demonstrated that HBcAb-positive donors can be safely used in HBsAb-negative RT recipients with lamivudine prophylaxis without the need for intravenous immunoglobulins (HBIg).
HBsAg(+) Donor as a Kidney Transplantation Deceased Donor
2008, Transplantation ProceedingsCitation Excerpt :But post-transplantation hepatitis was more frequent among HBsAg(+) patients. Recently Veroux et al6,7 reported their result of 100% patient and graft survivals with 23 months follow-up using renal donors with HBV. Berber et al8 also presented that transplants from HBsAg(+) and HBeAg(−) HBV DNA(−) donors seem to carry no risk to recipients who were immune to HBV.
Kidney Transplantation From Donors With Viral B and C Hepatitis
2006, Transplantation Proceedings