Solid Organ Transplantation From Hepatitis B Virus–Positive Donors: Consensus Guidelines for Recipient Management

Abstract

Use of organs from donors testing positive for hepatitis B virus (HBV) may safely expand the donor pool. The American Society of Transplantation convened a multidisciplinary expert panel that reviewed the existing literature and developed consensus recommendations for recipient management following the use of organs from HBV positive donors. Transmission risk is highest with liver donors and significantly lower with non‐liver (kidney and thoracic) donors. Antiviral prophylaxis significantly reduces the rate of transmission to liver recipients from isolated HBV core antibody positive (anti‐HBc+) donors. Organs from anti‐HBc+ donors should be considered for all adult transplant candidates after an individualized assessment of the risks and benefits and appropriate patient consent. Indefinite antiviral prophylaxis is recommended in liver recipients with no immunity or vaccine immunity but not in liver recipients with natural immunity. Antiviral prophylaxis may be considered for up to 1 year in susceptible non‐liver recipients but is not recommended in immune non‐liver recipients. Although no longer the treatment of choice in patients with chronic HBV, lamivudine remains the most cost‐effective choice for prophylaxis in this setting. Hepatitis B immunoglobulin is not recommended.

Donor selection in the modern era

“…The strategy of accepting hearts from HCV+ donors merits close attention, and this data will be forthcoming. In the meantime, use of hearts from donors with Hepatitis B virus infection (HBV core Ab+) is increasingly common, with low risk of viral transmission in thoracic transplant recipients, and the availability of effective anti-viral prophylaxis with lamivudine or entecavir, especially for HBV non-immune recipients (45). Use of organs from donors infected with human immunodeficiency virus (HIV), on the other hand, remains restricted to research protocols in thoracic transplantation, while recent evidence from South Africa demonstrating the short-term safety of organ transplantation between HIV-© Annals of Cardiothoracic Surgery.…”

Different Courses of Hepatitis B Reinfection After Renal Transplant: A Case Report

“…Transmission risks are highest with liver donors and significantly lower with nonliver (kidney and thoracic) donors. 3 Immunization against HBV in kidney transplant recipients is recommended. Despite a high prevalence of protective anti-HBs titer at kidney transplantation, the loss of protective immunity during the following year has been considerable, particularly when the initial anti-HBs titer is < 100 IU/L.…”

“…Antiviral prophylaxis may be considered for up to 1 year in susceptible nonliver recipients but is not recommended in immune nonliver recipients. 3 The Kidney Disease Improving Global Outcomes (KDIGO) guideline suggests prophylaxis with tenofovir, entecavir, or lamivudine to all HBsAgpositive renal transplant recipients, and treatment with adefovir or tenofovir is recommended for transplant recipients with lamivudine resistance (45 log10 copies/mL rebound of HBV DNA). 5 However, reinfection or reactivation of HBV may also occur without resistance of lamivudine.…”

Transplant Infectious Diseases: A Review of the Scientific Registry of Transplant Recipients Published Data

“…These include the American Society of Transplantation infectious diseases guidelines in 2009 and 2013 (33,34) and the international consensus guidelines on CMV (35). More recently, consensus guidelines on the use of organs from HBV + donors were published (13). More recently, consensus guidelines on the use of organs from HBV + donors were published (13).…”