Outcomes Among Children Who Received a Kidney Transplant in the United States From a Hepatitis B Core Antibody-Positive Donor, 1995-2010.
BACKGROUND
Accepting kidneys for transplant from donors with a history of hepatitis B virus infection may increase the availability of organs for those with end-stage kidney disease. In adult recipients, kidney transplants from hepatitis B virus core antibody-positive donors have resulted in favorable graft and patient survival rates. However, pediatric organ transplant recipients have developing immune systems and a higher risk of infectious complications than adults. Accordingly, little is known about the outcomes of children who have received a kidney transplant from a hepatitis B virus core antibody-positive donor.


METHODS
We included 11 898 children ≤18 years of age who received a first kidney transplant in the United States between January 1, 1995, and December 31, 2010, and who were recorded in the Scientific Registry of Transplant Recipients. We examined differences in graft and patient survival rates among children who received a kidney transplant from a hepatitis B virus core antibody-positive donor.


RESULTS
There were 199 children (1.7%) who received a kidney transplant from a hepatitis B virus core antibody-positive donor. More than 80% of these transplants occurred in recipients who were hepatitis B virus core antibody and surface antigen negative. After a median follow-up of 7.9 years, there were no significant differences in the adjusted graft (hazard ratio [HR], 1.03 [95% confidence interval (CI), 0.80-1.31]) or patient (HR, 1.12 [95% CI, 0.73-1.73]) survival rates according to donor core antibody status.


CONCLUSIONS
It may be acceptable, on a case-by-case basis, to consider hepatitis B virus core antibody-positive donors for kidney transplants to seroprotected children with end-stage kidney disease.
Division of Nephrology, Children's Hospital of Philadelphia.
Rebecca L
RL
Ruebner
Division of Nephrology, Children's Hospital of Philadelphia.
Taylor
T
Moatz
Division of Nephrology, Children's Hospital of Philadelphia.|Department of Biostatistics and Epidemiology.
Sandra
S
Amaral
Department of Biostatistics and Epidemiology.|Department of Medicine, University of Pennsylvania, Philadelphia.
Peter P
PP
Reese
Department of Medicine, University of Pennsylvania, Philadelphia.
Emily A
EA
Blumberg
Division of Nephrology, Seattle Children's Hospital, Washington.
Jodi M
JM
Smith
Department of Infectious Disease, Cincinnati Children's Hospital Medical Center, Ohio.
Lara
L
Danziger-Isakov
Division of Nephrology, Children's Hospital of Philadelphia.
Benjamin L
BL
Laskin
D000293:Adolescent; D002648:Child; D005260:Female; D006509:Hepatitis B / Q000635:transmission*; D006510:Hepatitis B Antibodies / Q000276:immunology*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D012042:Registries; D012306:Risk; D015996:Survival Rate; D014019:Tissue Donors; D016896:Treatment Outcome; D014481:United States
D006510:Hepatitis B Antibodies
children; hepatitis B; kidney transplant