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Outcomes Among Children Who Received a Kidney Transplant in the United States From a Hepatitis B Core Antibody–Positive Donor, 1995–2010
Rebecca L. Ruebner1, Taylor Moatz1, Sandra Amaral1,2, Peter P. Reese2,3, Emily A. Blumberg3, Jodi M. Smith4, Lara Danziger-Isakov5 and Benjamin L. Laskin1
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Author Affiliations
1Division of Nephrology, Children's Hospital of Philadelphia
2Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia
3Department of Medicine, University of Pennsylvania, Philadelphia
4Division of Nephrology, Seattle Children's Hospital, Washington
5Department of Infectious Disease, Cincinnati Children's Hospital Medical Center, Ohio
Corresponding Author: Benjamin L. Laskin, MD, MS, Children's Hospital of Philadelphia, 34th St and Civic Center Boulevard, Philadelphia, PA 19004. E-mail: [email protected].
Received June 4, 2015.
Accepted September 15, 2015.
Abstract
Background Accepting kidneys for transplant from donors with a history of hepatitis B virus infection may increase the availability of organs for those with end-stage kidney disease. In adult recipients, kidney transplants from hepatitis B virus core antibody–positive donors have resulted in favorable graft and patient survival rates. However, pediatric organ transplant recipients have developing immune systems and a higher risk of infectious complications than adults. Accordingly, little is known about the outcomes of children who have received a kidney transplant from a hepatitis B virus core antibody–positive donor.
Methods We included 11 898 children ≤18 years of age who received a first kidney transplant in the United States between January 1, 1995, and December 31, 2010, and who were recorded in the Scientific Registry of Transplant Recipients. We examined differences in graft and patient survival rates among children who received a kidney transplant from a hepatitis B virus core antibody–positive donor.
Results There were 199 children (1.7%) who received a kidney transplant from a hepatitis B virus core antibody–positive donor. More than 80% of these transplants occurred in recipients who were hepatitis B virus core antibody and surface antigen negative. After a median follow-up of 7.9 years, there were no significant differences in the adjusted graft (hazard ratio [HR], 1.03 [95% confidence interval (CI), 0.80–1.31]) or patient (HR, 1.12 [95% CI, 0.73–1.73]) survival rates according to donor core antibody status.
Conclusions It may be acceptable, on a case-by-case basis, to consider hepatitis B virus core antibody–positive donors for kidney transplants to seroprotected children with end-stage kidney disease.
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