Between September 2015 and November 2020, researchers reviewed data from patients who received liver, kidney, pancreas, or heart transplants at a transplant center and gathered recipient and donor data on HBV serologies, prophylactic strategies, and known risk factors associated with HBV reactivation in posttransplant patients.
During the study period, 2,126 solid organs were transplanted into 1,951 patients. Among these, 360 transplants involved recipients (R), donors (D), or both who were hepatitis B core antibody (HBcAb[+])/hepatitis B surface antigen (HBsAg[-]). Posttransplant HBV DNA was detected in 0/10 heart, 0/3 pancreas-kidney, 2/1,517 (0.1%) kidney, and 10/430 (2.3%) liver recipients. Both kidney recipients with HBV DNA tested negative upon retesting without treatment. HBV DNA developed in 17.5% of liver recipients who were D+/R- for HBcAb (10/57). All 10 liver recipients who developed HBV DNA had received prophylaxis. At a median of 886 days (range 139 to 2,287) posttransplant, five patients developed detectable HBV DNA while on prophylaxis. Another five patients developed HBV DNA after ceasing prophylaxis at a median of 955 days (range 756 to 2,003) posttransplant and 596 days (range 395 to 1,638) after discontinuing prophylaxis.
Based on their findings, the authors concluded that HBcAb was discovered in a noteworthy percentage of solid organ transplant donors and recipients, and HBcAb(+)/HBsAg(-) liver allografts represent the primary risk factor for HBV posttransplant. Moreover, utilizing current monitoring strategies, HBV infection in nonliver solid organ transplants has minimal risk, the infection can transpire long after the transplant event, and monitoring and prophylaxis strategies in this group should be reexamined.
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