RISKS OF TRANSPLANTING - KIDNEYS FROM HEPATITIS-B SURFACE ANTIGEN-NEGATIVE, HEPATITIS-B CORE ANTIBODY-POSITIVE DONORS

Background. As the number of patients on the United States kidney tran splant list increases, investigation into the utility of transplanting organs formerly considered marginal or undesirable has intensified. U sing kidneys from hepatitis B surface antigen (HBsAg)-positive donors is thought to place recipients at excessive risk of graft failure, mor bidity, and mortality. However, the risks of using kidneys from HBsAg- negative but hepatitis B core antibody (HBcAb)-positive donors have no t been defined. Methods. Between 1990 and 1994, our group transplanted 1067 cadaveric kidneys, including 38 from HBsAg(-)/HBcAb(+) donors. O f these 38 kidneys, 27 were transplanted into HBcAb(-) recipients (gro up 1) and 11 were transplanted into HBcAb(+) recipients (group 2). Gro up 1 and 2 patients received no hepatitis immunoglobulin therapy after transplantation and received the same immunosuppression and rejection therapies as recipients of kidneys from HBcAb(-) donors. Results. Aft er transplantation, none of the group I patients became HBsAg(+), thre e became hepatitis B surface antibody (HBsAb)-positive, and two became HBcAb(+), Of the group 2 patients, none became newly HBsAg(+) or HBsA b(+). No patient receiving a kidney from an HBsAg(-)/HBcAb(+) donor de veloped signs or symptoms of clinical hepatitis B, Graft and patient s urvival rates were similar in both groups and similar to the rates of the 1029 recipients of kidneys from HBcAb(-) donors. Conclusions. Reci pients of kidneys from HBsAg(-)/HBcAb(+) donors are at a small risk of hepatitis B seroconversion but are at no excess risk of graft failure or short-term morbidity or mortality.