Expanding The Donor Pool: First Use Of Hepatitis B Virus NAT Positive Solid Organ Allografts Into Seronegative Recipients
*Aaron M Delman, *Kevin M Turner, *Latifa S Silski, *Tiffany C Lee, *Keith Luckett, *Madison C Cuffy, *Kamran Safdar, *Nadeem Anwar, *Ralph C Quillin, III, *Amit Govil, *Khurram Bari, Shimul A Shah
The University of Cincinnati, Cincinnati, OH
Objectives: Despite an ongoing organ shortage, the use of hepatitis B virus (HBV) nucleic-acid test positive (NAT+) organs into nonviremic recipients has not been widely performed and outcomes are unknown.
Methods: From 1/2017 – 10/2020, 56/364 seronegative kidney transplant (KT) recipients (15.4%) and 33/462 liver transplant (LT) recipients (7.1%) received HBV NAT+ organs. Patients were consented pre-operatively, received HBV immunization if non-immune, and were maintained on entecavir. Primary endpoints were post-transplant HBV viremia, graft and patient survival.
Results: With median follow-up of 1 year, there were no HBV-related complications in the 89 HBV NAT+ recipients. Only 9 KTs (16.4%) and 9 LTs (27.3%) experienced post-transplant viremia with a median of 185 (KT) and 269 (LT) days until HBV NAT+ detection. Overall 15/18 (83.3%) of viremic episodes resolved to HBV NAT- after 80 days with entecavir. Currently, 98.2% of KT recipients and 93.9% of LT recipients are NAT- with median follow-up of 13 months; while zero KT and 8 LT (24.2%) recipients are HBV surface antigen positive indicating chronic infection. KT and LT patient and allograft survival were not different between HBV NAT+ and HBV NAT- recipients (log-rank p>0.05) while HBV NAT+ KT recipients had decreased waitlist time (p<0.01).
Conclusions: This is the first and largest series confirming transplantation of HBV NAT+ organs into HBV seronegative recipients can be accomplished safely without chronic viremia or decrease in survival. Increasing the utilization of HBV NAT+ organs in non-viremic recipients can play a role in decreasing the national organ shortage.
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