title: Review of the use of hepatitis B core antibody-positive kidney donors.
abstract: This article reviews the risks of transplanting hepatitis B core antibody (anti-HBc)-positive (+) kidneys and strategies to minimize the risks to the recipient. In the United States, there is a shortage of kidneys available for transplantation. Presently, 4% of kidneys transplanted are anti-HBc (+). In published retrospective studies, the serologic conversion rate for recipients of anti-HBc (+) kidneys varied between 0% and 27%; and the development of elevated hepatic transaminases varied between 0% and 26%. Only one published article had a trend toward increased risk of graft loss. Other published studies had no significant difference in graft or patient survival. Factors that influence the risk of transmission include hepatitis B viral load, vaccination, and antiviral therapy. If the donor is anti-HBc (+) and hepatitis B DNA negative, the risk of transmission is negligible; unfortunately, this information may not be available at the time of transplant. Vaccinated recipients with a protective hepatitis B surface antibody of at least 10 mIU/mL had a 4% conversion rate compared with 10% in recipients with antibody levels not exceeding 10 mIU/mL. Both hepatitis B immunoglobulin and lamivudine have been used in recipients of anti-HBc (+) kidneys to decrease seroconversion with success. The data do support the use of anti-HBc (+) kidneys if precautions are taken. The recipients should be informed of the risk, should be vaccinated with an adequate response, and should have surveillance serologies performed.
authors.affiliation: Jewish Hospital, Louisville Kentucky, KY 40202, USA.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Ouseph
authors.forename: Mary
authors.initials: M
authors.lastname: Eng
authors.forename: Kadiyala
authors.initials: K
authors.lastname: Ravindra
authors.forename: Guy N
authors.initials: GN
authors.lastname: Brock
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Buell
authors.forename: Michael R
authors.initials: MR
authors.lastname: Marvin
mesh_terms: D006509:Hepatitis B / Q000188:drug therapy / Q000276:immunology* / Q000517:prevention & control / Q000635:transmission*; D006510:Hepatitis B Antibodies / Q000276:immunology*; D006514:Hepatitis B Surface Antigens / Q000276:immunology; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D019259:Lamivudine / Q000627:therapeutic use; D008099:Liver / Q000201:enzymology; D018579:Patient Selection; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D018570:Risk Assessment; D014019:Tissue Donors; D000637:Transaminases / Q000378:metabolism; D019562:Viral Load
chemical_list: D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D000637:Transaminases