Hepatitis B core antibody positive donors as a safe and effective therapeutic option to increase available organs for lung transplantation.

Abstract

BACKGROUND:

The use of hepatitis B core antibody (HBcAb+) and hepatitis C antibody (HCV Ab+) positive donors represents one strategy to increase available donor organs, but this remains controversial because of concern for viral transmission to recipients. We hypothesized that isolated HBcAb+ donors represent minimal risk of viral transmission in vaccinated lung transplant (LTx) recipients.

METHODS:

A retrospective study was performed of LTx recipients who received HBcAb+ or HCV Ab+ pulmonary allografts. We analyzed liver function studies, viral hepatitis screening tests, quantitative polymerase chain reaction for hepatitis B viral DNA (HBV DNA) and hepatitis C viral RNA (HCV RNA), freedom from bronchiolitis obliterans syndrome, acute rejection, and survival.

RESULTS:

Between April 1992 and August 2003, 456 LTx operations were performed. Twenty-nine patients (HB group) received HBcAb+ allograft transplants with a median posttransplant follow-up of 24.5 months. Three critically ill patients (HC group) received HCV Ab+ allografts with a median follow-up of 21.5 months. One-year survival for the HB group is 83% versus 82% for all patients who received non-HB organs (P=0.36). No patient in the HB group developed clinical liver disease because of viral hepatitis, and all patients alive (n=21) at follow-up are, to date, HBV DNA and/or HBcAb negative. All patients in the HC group tested HCV RNA positive; one patient died of liver failure at 22 months.

CONCLUSIONS:

Risk of viral transmission with HCV Ab+ allografts seems high after LTx. However, the use of HBcAb+ pulmonary allografts in recipients with prior hepatitis B vaccination seems to be a safe and effective strategy to increase organ availability.

• Authors: Matthew G Hartwig, Vijay Patel, Scott M Palmer, Edward Cantu, James Z Appel, Robert H Messier, R Duane Davis
• Journal: Transplantation (Transplantation) Vol. 80 Issue 3 Pg. 320-5 (Aug 15 2005) ISSN: 0041-1337 [Print] United States
• PMID: 16082326 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Hepatitis B Antibodies
• Hepatitis B Core Antigens
• Immunosuppressive Agents
• RNA, Viral
• DNA

Topics

• Adult
• Bronchiolitis Obliterans (etiology, therapy)
• Cadaver
• DNA (metabolism)
• Female
• Follow-Up Studies
• Graft Rejection
• Hepacivirus (genetics)
• Hepatitis B (immunology)
• Hepatitis B Antibodies (metabolism)
• Hepatitis B Core Antigens (immunology, metabolism)
• Hepatitis B virus (genetics)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Liver (metabolism)
• Lung Transplantation (methods)
• Male
• Middle Aged
• Polymerase Chain Reaction
• RNA, Viral (metabolism)
• Retrospective Studies
• Time Factors
• Tissue Donors
• Tissue and Organ Procurement (methods)