Kidney transplantation from anti-HBc+ donors: results from a retrospective Italian study.
BACKGROUND
The risk of transmitting a hepatitis B virus (HBV) infection from donor kidneys with a past HBV serological profile may be negligible. Data on HBV transmission to kidney transplant recipients from donor organs that were anti-HBc/HBsAg in Italy has not been previously reported. Anti-HBc testing in cadaver organ donors has been mandatory in Italy since 2002, when anti-HBc determinations were included in the National Guidelines for donor evaluation. Therefore, prior to that date kidney recipients from anti-HBc/HBsAg donors can be identified retrospectively where stored serum is available for testing.


METHODS
The prevalence of anti-HBc Italian organ donors, the incidence of HBV transmission according to the recipients' HBV status (vaccinated, recovered, or naive), and the clinical impact (5-year graft and patient survival rates) in the North Italy Transplant program was evaluated by retrospectively screening for anti-HBc antibodies in the sera of cadaver kidney donors used in transplants from 1997 to 1999.


RESULTS
Two hundred and ten donors were found to have been anti-HBc. At the time of the study, no active infection was observed in any of the 344 HBsAg recipients, but 4/140 (2.86%) of the vaccinated recipients were found to have been anti-HBc/HBsAg. None of these patients, however, had any biochemical or clinical history of HBV infection. Patient and graft survival rates of anti-HBc or anti-HBc kidney recipients did not differ statistically.


CONCLUSIONS
Kidney grafts from anti-HBc donors should be considered in all recipients because the benefit obtained from the transplantation out weighs the negligible risk of HBV transmission.
De Feo
Tullia M
TM
Department Trasfusionale e di Riferimento per il Trapianto di Organi e Tessuti, IRCCS Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy. tullia.defeo@policlinico.mi.it
Grossi
Paolo
P
Poli
Francesca
F
Mozzi
Fulvio
F
Messa
Piergiorgio
P
Minetti
Enrico
E
Sandrini
Silvio
S
Boschiero
Luigi
L
Rigotti
Paolo
P
Maresca
Cristina
C
Rolla
Davide
D
Chiaramonte
Stefano
S
Gotti
Eliana
E
Caldara
Rossana
R
Briano
Giulio
G
Scalamogna
Mario
M
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006509:Hepatitis B / Q000276:immunology / Q000635:transmission; D006510:Hepatitis B Antibodies / Q000032:analysis* / Q000276:immunology*; D006512:Hepatitis B Core Antigens / Q000276:immunology*; D006515:Hepatitis B virus / Q000276:immunology*; D006801:Humans; D007223:Infant; D007558:Italy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D012189:Retrospective Studies; D014019:Tissue Donors
D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens