Clin Infect Dis. 2020 Feb 26. pii: ciaa178. doi: 10.1093/cid/ciaa178. [Epub ahead of print]
Kidney Transplantation from HBsAg+ Living Donors to HBsAg- Recipients: Clinical Outcomes at a High-volume Center in China.
Wang XD1,2, Liu JP1,2, Song TR1,2, Huang ZL1,2, Fan Y1,2, Shi YY3, Chen LY4, Lv YH5, Xu ZL5, Li XH6, Wang L1,2, Lin T1,2.
Author information
1
Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
2
Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
3
Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
4
Department of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
5
West China School of Clinical Medicine, Sichuan University, Chengdu, Sichuan, China.
6
Department of Health Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China.
Abstract
BACKGROUND:
Data on kidney transplantation (KTx) from hepatitis B surface antigen (HBsAg)+ donors to HBsAg- recipients [D(HBsAg+)/R(HBsAg-)] are limited. We aimed to report the outcomes of D(HBsAg+)/R(HBsAg-) KTx in recipients with or without hepatitis B surface antibody (HBsAb).
METHODS:
Eighty-three D(HBsAg+)/R(HBsAg-) living KTx cases were retrospectively identified. The 384 cases of KTx from hepatitis B core antibody (HBcAb)+ living donors to HBcAb- recipients [D(HBcAb+)/R(HBcAb-)] were used as the control group. Primary endpoint was post-transplant HBsAg -→+.
RESULTS:
Before KTx, 24 donors (28.9%) in the D(HBsAg+)/R(HBsAg-) group were hepatitis B virus (HBV) DNA+, and 20 recipients were HBsAb-. All eighty-three D(HBsAg+)/R(HBsAg-) recipients received HBV prophylaxis, while no D(HBcAb+)/R(HBcAb-) recipients received prophylaxis. After a median follow-up of 36 months (range 6-106) and 36 months (range 4-107) for the D(HBsAg+)/R(HBsAg-) and D(HBcAb+)/R(HBcAb-) groups, respectively, 2/83 (2.41%) D(HBsAg+)/R(HBsAg-) recipients and 1/384 (0.26%) D(HBcAb+)/R(HBcAb-) became HBsAg+, accompanied with HBV DNA+ (P=0.083). The three recipients with HBsAg-→+ were exclusively HBsAb-/HBcAb- before KTx. Recipient deaths were more frequent in the D(HBsAg+)/R(HBsAg-) group (6.02% vs. 1.04%, P=0.011), while liver and graft function, rejection, infection, and graft loss were not significantly different. In univariate analyses, pre-transplant HBsAb-/HBcAb- combination in the D(HBsAg+)/R(HBsAg-) recipients carried a significantly higher risk of HBsAg-→+, HBV DNA-→+, and death.
CONCLUSIONS:
Living D(HBsAg+)/R(HBsAg-) KTx in HBsAb+ recipients provides excellent graft and patient survivals without HBV transmission. HBV transmission risks should be more balanced with respect to benefits of D(HBsAg+)/R(HBsAg-) KTx in HBsAb-/HBcAb- candidates.