Successful outcome of kidney transplantation from a HBV-DNA positive donor into recipients with cleared HBV-infection using a pre-emptive therapy approach.
BACKGROUND
Donor-derived transmission of hepatitis B virus (HBV) may cause serious complications after transplantation. To date, transplantation from HBV-infected donors to HBV-infected recipients seems feasible, although this is recommended with prophylaxis with specific drugs and antibodies only, whereas pre-emptive strategies are rarely used.


OBJECTIVE
Here, we assessed the success of transplantation of kidneys from a chronically HBV-infected deceased donor (HBs-antigen positive, anti-HBc positive, HBV-DNA positive) to two recipients with cleared HBV-infection (HBs-antigen negative, anti-HBc positive, anti-HBs >100 IU/l) where risk-assessment was performed using a pre-emptive approach in the absence of prophylaxis.


METHODS
Pre-emptive monitoring included assessment for evidence of infection by analysis of liver enzymes, viral load, and humoral and cellular immunity against HBV and CMV.


RESULTS
In line with undetectable HBV-load, HBc-specific T-cell frequencies remained stable (mean 0.46+/-0.10% and 0.06+/-0.03%), whereas CMV-specific T-cell frequencies in one patient showed dynamic changes that coincided with CMV-viremia. Likewise, HBV-specific antibody titres were stable. Liver enzymes demonstrated absence of liver-cell injury and renal function was good (creatinine 1.8 and 0.8 mg/dl at last follow-up after 39 and 38 months, respectively).


CONCLUSIONS
When combined with careful HBV-monitoring, kidneys from HBV-infected donors may be transplanted into HBV-immune recipients without the need for specific prophylaxis.
Mohrbach
Janine
J
Department of Transplant and Infection Immunology, Institute of Virology, Saarland University, D-66421 Homburg, Germany.
Janssen
Martin W W
MW
Heine
Gunnar H
GH
Gärtner
Barbara C
BC
Fliser
Danilo
D
Sester
Martina
M
Sester
Urban
U
D000328:Adult; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis* / Q000276:immunology / Q000821:virology; D006510:Hepatitis B Antibodies / Q000097:blood*; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D006801:Humans; D007111:Immunity, Cellular; D016030:Kidney Transplantation / Q000379:methods*; D008099:Liver / Q000201:enzymology; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors; D016896:Treatment Outcome; D019562:Viral Load
D004279:DNA, Viral; D006510:Hepatitis B Antibodies