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

Matthew G. Hartwig, Vijay Patel, Scott M. Palmer, Edward Cantu, James Z. Appel, Robert H. Messier, R. Duane Davis

Research output: Contribution to journalArticle

31 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)320-325
Number of pages6
JournalTransplantation
Volume80
Issue number3
DOIs
StatePublished - Aug 15 2005
Externally publishedYes

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Keywords

  • Bronchiolitis obliterans syndrome
  • Hepatitis B
  • Lung transplantation

ASJC Scopus subject areas

  • Transplantation

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