Kidney transplantation from brain-dead donors with hepatitis B or C in South Korea: a 2015-2020 Korean Organ Transplantation Registry data analysis

Abstract

Background: Because of the Korean Network for Organ Sharing (KONOS) guidelines, brain-dead donor transplantation (liver/kidney) from Hepatitis B or C (+) donors only can be done to the same hepatitis (+) recipients. In the US, organ transplantation from hepatitis (+) donors to (-) recipients has been implemented for more than 15 years. We need to consider the safety of transplantation from hepatitis B or C (+) donors to hepatitis (-) recipients. The aim of the study is to show the transplantation results from hepatitis B or C (+) donors to each hepatitis (-) recipient and make it as a starting point for the consideration. Methods: This is a retrospective, observational study using data from Korean Organ Transplantation Registry (KOTRY) data analysis. A total of 2,105 kidney transplantations from brain-dead donors, from January 2015 to June 2020 were included in this study. It consists of 80 HBV (+) grafts, 12 HCV (+) grafts and 2013 hepatitis (-) grafts. Results: In donor characteristics, median ages of the three groups [HBV (+), HCV (+), hepatitis (-)] were 57.4±10.1, 50.1±11.8 and 48.7±14.9, respectively (P=0.02; HCV (+)-hepatitis (-), P=0.04). Baseline serum creatinine (median, mg/dL) were 1.25±0.87, 1.45±0.46 and 1.57±1.34, respectively (P=0.02; HBV (+)-hepatitis (-), P=0.01). In recipient characteristics, male/female ratio were 60/20, 7/5 and 1228/785, respectively (P=0.04; HBV (+)-hepatitis (-), P=0.04). Wait time (median, days) were 1550.8±1145.5, 1434.3±957.2 and 2188±1207.9, respectively (P<0.001; HBV (+)-hepatitis (-), P<0.001). In posttransplant results, there were no significant differences in follow-up serum creatinine, survival, postop hospital day and complication between the three groups. From a Kaplan-Meier analysis, overall patient survival rates after KT at 5 years were 95%, 100% and 76.2%, respectively (HBV [+]-hepatitis [-], P<0.001). Overall graft survival rates after KT at 5 years were 95%, 83.3% and 84.5%, respectively (HBV [+]-hepatitis [-], P=0.02). Conclusions: There were no differences in baseline, postop and follow-up serum creatinine between the three groups. Moreover, 5-year patient and graft survival were significantly higher in HBV (+) grafts than in hepatitis (-) grafts. Do not hesitate to consider implementing brain-dead donor transplantation from hepatitis (+) donors to hepatitis (-) recipients.