Elsevier

Transplantation Proceedings

Volume 37, Issue 6, July–August 2005, Pages 2467-2468
Transplantation Proceedings

Renal transplantation
Outcome
Kidney Transplantation From Hepatitis B Surface Antigen–Positive Donors Into Hepatitis B Surface Antigen–Positive Recipients: Preliminary Findings

https://doi.org/10.1016/j.transproceed.2005.06.011Get rights and content

Abstract

Introduction

The success of renal transplantation as a treatment for end-stage renal disease has created a chronic shortage of donor organs. We present our initial experience in transplanting kidneys from hepatitis B surface antigen (HbsAg)–positive donors into HbsAg-positive recipients.

Material and Methods

From January 2002 to March 2004, 5 patients with end-stage renal disease, hepatitis B virus (HBV) infection, and HbsAg seropositivity underwent a kidney transplantation from a cadaveric HbsAg-positive donor. The median time on the waiting list was 8 months, compared with the median of 3 years on the national waiting list.

Results

One patient experienced an acute rejection; 1 patient had an increase in serum level of aspartate aminotransferase (AST)/alanine aminotransferase (ALT) with no signs of recurrence of hepatits. Graft and patient survival at a median follow-up of 12 months was 100%.

Conclusions

Although the number of patients is small and the follow-up is short, our results suggest that HbsAg-positive donors can be considered as an alternative donor source because their kidneys are allocated to the matched serology-positive recipients, shortening their time on the waiting list.

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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  • M.A. Taludker et al.

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There are more references available in the full text version of this article.

Cited by (14)

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    2016, Seminars in Nephrology
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    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 Reviews
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    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 Proceedings
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    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.

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