title: Use of renal allografts from donors positive for hepatitis B core antibody confers minimal risk for subsequent development of clinical hepatitis B virus disease.
abstract: BACKGROUND
  The risk associated with transplantation of renal allografts from hepatitis B virus core antibody-positive (HBcAb(+)), hepatitis B virus surface antigen-negative (HBsAg(-)) donors is not well defined.
  
  
  METHODS
  Over 4 years, we performed 45 kidney transplants from IgG HBcAb(+), IgM HBcAb(-), HBsAg(-) donors into recipients with a history of prior hepatitis B virus (HBV) infection or reported vaccination. We examined HBV-related outcomes in these 45 patients, in comparison with 45 recipients of allografts from HBcAb(-) donors (matched for transplant type, date, and pretransplant HBV antibodies). We sought evidence for HBV transmission by testing posttransplant sera for the presence of HBcAb, hepatitis B virus surface antibody, and HBsAg. Additionally, we analyzed alanine aminotransferase profiles and allograft survival rates for all patients.
  
  
  RESULTS
  No patient receiving an allograft from an HBcAb(+) donor developed clinical HBV infection. No patient receiving an allograft from an HBcAb(+) donor had HBsAg detected through retrospective testing of stored sera or through prospective routine clinical evaluation and care. However, among the HBcAb(+) kidney recipients, 27% developed new HBcAb and/or hepatitis B virus surface antibody after transplant; in contrast, only 4% of control patients developed new antibody responses (relative risk=4.94; confidence interval 1.07-22.83). Among the recipients of HBcAb(+) organs, 18% developed elevated transaminases after transplant, in comparison with 36% of the controls. No association was found between "seroconverter" status and elevated alanine aminotransferase profiles in either group.
  
  
  CONCLUSIONS
  Transplantation of renal allografts from HBcAb(+), HBsAg(-) donors was not associated with clinically detectable HBV disease or antigenemia. However, recipients had a significantly increased risk of HBV seroconversion, consistent with exposure to HBV antigen. These results suggest that HBcAb(+) kidneys can be safely used if transplanted into appropriate recipients, but highlight the need for effective HBV vaccination and vaccine-response monitoring in potential recipients.
authors.affiliation: Department of Surgery, University of Maryland School of Medicine, Baltimore 21201, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Madayag
authors.forename: L B
authors.initials: LB
authors.lastname: Johnson
authors.forename: S T
authors.initials: ST
authors.lastname: Bartlett
authors.forename: E J
authors.initials: EJ
authors.lastname: Schweitzer
authors.forename: N T
authors.initials: NT
authors.lastname: Constantine
authors.forename: R J
authors.initials: RJ
authors.lastname: McCarter
authors.forename: P C
authors.initials: PC
authors.lastname: Kuo
authors.forename: S
authors.initials: S
authors.lastname: Keay
authors.forename: D W
authors.initials: DW
authors.lastname: Oldach
mesh_terms: D000328:Adult; D002102:Cadaver; D005260:Female; D006509:Hepatitis B / Q000635:transmission*; D006510:Hepatitis B Antibodies / Q000276:immunology*; D006512:Hepatitis B Core Antigens / Q000276:immunology*; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012306:Risk; D014019:Tissue Donors
chemical_list: D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens