THE RISK OF TRANSMISSION OF HEPATITIS-B FROM HBSAG(-), HBCAB(-) ORGANDONORS(), HBIGM()

Liver allografts from HBcAb(+), IgM(-), HEsAg(-) donors can transmit H BV to uninfected recipients. We currently no longer accept these liver s for transplantation while continuing to accept the kidneys. The purp ose of this study is to determine the risk of donor-transmitted HBV in fections from HBcAb(+), HBIgM(-), HBsAg(-) organ donors and determine if the risk of donor-transmitted HBV infections and their severity is dependent on the organ being transplanted. This study consists of a re trospective review of the posttransplant course of recipients of HBcAb (+), HBIgM(-), HBsAg(-) donors accepted at UCSF from 6/85 to 12/93. Tr ansmitted HBV infection was defined as one in which the recipient chan ged from HBsAg(-) prior to transplantation to HBsAg(+) posttransplant, with no other source. There were 25 of 1190 donors who were HBcAb(f), HBIgM(-), HBsAg(-); 1/42 kidney, 3/6 liver, and 0/7 heart HBsAg(-) tr ansplant recipients of organs from these donors became HBsAg(f) after transplantation. This difference in infection rate (liver vs, kidney a nd heart) is statistically significant. The clinical course of the liv er recipients was also more severe. Ah of the patients who became infe cted were HBsAb(-) and HBcAb(-) prior to transplant. We conclude that (1) HBV can be transmitted from HBcAb(+), HBIgM(-), HBsAg(-) organ don ors, (2) the rate of transmission is highest and severity of infection is worst in the liver recipients; and (3) we will continue to transpl ant kidneys from these donors, preferably into immunized recipients.