USE OF RENAL-ALLOGRAFTS FROM DONORS POSITIVE FOR HEPATITIS-B CORE ANTIBODY CONFERS MINIMAL RISK FOR SUBSEQUENT DEVELOPMENT OF CLINICAL HEPATITIS-B VIRUS-DISEASE

Background The risk associated with transplantation of renal allograft s from hepatitis B virus core antibody-positive (HBcAb(+)), hepatitis B virus surface antigen-negative (HBsAg(-)) donors is not well defined , Methods. Over 4 years, we performed 45 kidney transplants from IgG H BcAb(+), IgM HBcAb(-), HBsAg(-) donors into recipients with a history of prior hepatitis B virus (HBV) infection or reported vaccination, We examined HBV-related outcomes in these 45 patients, in comparison wit h 45 recipients of allografts from HBcAb(-) donors (matched for transp lant type, date, and pretransplant HBV antibodies), We sought evidence for HBV transmission by testing posttransplant sera for the presence of HBcAb, hepatitis B virus surface antibody, and HBsAg, Additionally, we analyzed alanine aminotransferase profiles and allograft survival rates for all patients, Results, No patient receiving an allograft fro m an HBcAb(+) donor developed clinical HBV infection. No patient recei ving an allograft from an HBcAb(+) donor had HBsAg detected through re trospective testing of stored sera or through prospective routine clin ical evaluation and care. However, among the HBcAb(+) kidney recipient s, 27% developed new HBcAb and/or hepatitis B virus surface antibody a fter transplant; in contrast, only 4% of control patients developed ne w antibody responses (relative risk=4.94; confidence interval 1.07-22. 83), Among the recipients of HBcAb(+) organs, 18% developed elevated t ransaminases after transplant, in comparison with 36% of the controls. No association was found between ''seroconverter'' status and elevate d alanine aminotransferase profiles in either group, Conclusions. Tran splantation of renal allografts from HBcAb(+), HBsAg(-) donors was not associated with clinically detectable HBV disease or antigenemia. How ever, recipients had a significantly increased risk of HBV seroconvers ion, consistent with exposure to HBV antigen, These results suggest th at HBcAb(+) kidneys can be safely used if transplanted into appropriat e recipients, but highlight the need for effective HBV vaccination and vaccine-response monitoring in potential recipients.