Impact of hepatitis B core antibody status on outcomes of cadaveric renal transplantation: analysis of United network of organ sharing database between 1994 and 1999.
BACKGROUND
Organ shortage continues to be a major problem in transplantation. The use of organs from marginal donors who are hepatitis B surface antigen (HBsAg) negative and hepatitis B core antibody (anti-HBc Ab) reactive (+), could increase the donor pool substantially. Little information is available about the effects of anti-HBc Ab (+) donor status on viral transmission, and graft and patient survival. To address these issues, an analysis was performed using the United Network of Organ Sharing cadaveric kidney transplant database between 1994 to 1999.


METHODS
All cadaveric kidney transplants performed between 1994 to 1999 with negative HBsAg serology were evaluated. Viral transmission, and graft and patient outcomes were measured. The analysis included follow-up information in the United Network of Organ Sharing database through September 2000. A multivariate analysis was performed, using known confounding factors that may affect the outcomes in donors and recipients who were designated as (+) or (-) (D+/R+, ++D+/R-, D-/R-, and D-/R+) according to their anti-HBc Ab status.


RESULTS
Univariate analyses showed that graft and patient survival rates were statistically significantly lower in D+/R- compared with those who were D-/R-. However, multivariate regression analyses showed that neither donor nor recipient anti-HBc Ab status influenced the risk of graft failure or patient death after adjustment for other factors. Anti-HBc Ab (+) kidneys resulted in a higher incidence of anti-HBc antibody seroconversion but this was not associated with a higher incidence of HBsAg detection.


CONCLUSIONS
We conclude that renal allografts from anti-HBc Ab (+) donors should be considered for transplant especially in successfully immunized recipients.
Fong
Tse-Ling
TL
Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, 2011 Zonal Avenue HMR 101, Los Angeles CA 90033, USA.
Bunnapradist
Suphamai
S
Jordan
Stanley C
SC
Cho
Yong W
YW
D000328:Adult; D000704:Analysis of Variance; D002102:Cadaver; D016208:Databases, Factual; D005260:Female; D006085:Graft Survival / Q000276:immunology / Q000502:physiology*; D006509:Hepatitis B / Q000453:epidemiology; D006510:Hepatitis B Antibodies / Q000097:blood*; D006512:Hepatitis B Core Antigens / Q000276:immunology*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000145:classification / Q000401:mortality; D012042:Registries; D012044:Regression Analysis; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000458:organization & administration; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014481:United States
D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens