Hepatitis B core antibody positive donors as a safe and effective therapeutic option to increase available organs for lung transplantation.
BACKGROUND
The use of hepatitis B core antibody (HBcAb+) and hepatitis C antibody (HCV Ab+) positive donors represents one strategy to increase available donor organs, but this remains controversial because of concern for viral transmission to recipients. We hypothesized that isolated HBcAb+ donors represent minimal risk of viral transmission in vaccinated lung transplant (LTx) recipients.


METHODS
A retrospective study was performed of LTx recipients who received HBcAb+ or HCV Ab+ pulmonary allografts. We analyzed liver function studies, viral hepatitis screening tests, quantitative polymerase chain reaction for hepatitis B viral DNA (HBV DNA) and hepatitis C viral RNA (HCV RNA), freedom from bronchiolitis obliterans syndrome, acute rejection, and survival.


RESULTS
Between April 1992 and August 2003, 456 LTx operations were performed. Twenty-nine patients (HB group) received HBcAb+ allograft transplants with a median posttransplant follow-up of 24.5 months. Three critically ill patients (HC group) received HCV Ab+ allografts with a median follow-up of 21.5 months. One-year survival for the HB group is 83% versus 82% for all patients who received non-HB organs (P=0.36). No patient in the HB group developed clinical liver disease because of viral hepatitis, and all patients alive (n=21) at follow-up are, to date, HBV DNA and/or HBcAb negative. All patients in the HC group tested HCV RNA positive; one patient died of liver failure at 22 months.


CONCLUSIONS
Risk of viral transmission with HCV Ab+ allografts seems high after LTx. However, the use of HBcAb+ pulmonary allografts in recipients with prior hepatitis B vaccination seems to be a safe and effective strategy to increase organ availability.
Hartwig
Matthew G
MG
Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Patel
Vijay
V
Palmer
Scott M
SM
Cantu
Edward
E
Appel
James Z
JZ
Messier
Robert H
RH
Davis
R Duane
RD
D000328:Adult; D001989:Bronchiolitis Obliterans / Q000209:etiology / Q000628:therapy; D002102:Cadaver; D004247:DNA / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D016174:Hepacivirus / Q000235:genetics; D006509:Hepatitis B / Q000276:immunology*; D006510:Hepatitis B Antibodies / Q000378:metabolism*; D006512:Hepatitis B Core Antigens / Q000276:immunology / Q000378:metabolism*; D006515:Hepatitis B virus / Q000235:genetics; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008099:Liver / Q000378:metabolism; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000378:metabolism; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*
D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D007166:Immunosuppressive Agents; D012367:RNA, Viral; D004247:DNA