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Solid Organ Transplantation From Hepatitis B Virus–Positive Donors: Consensus Guidelines for Recipient Management |
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| Authors: | S. Huprikar L. Danziger‐Isakov J. Ahn S. Naugler E. Blumberg R. K. Avery C. Koval E. D. Lease A. Pillai K. E. Doucette J. Levitsky M. I. Morris K. Lu J. K. McDermott T. Mone J. P. Orlowski D. M. Dadhania K. Abbott S. Horslen B. L. Laskin A. Mougdil V. L. Venkat K. Korenblat V. Kumar P. Grossi R. D. Bloom K. Brown C. N. Kotton D. Kumar |
| Affiliation: | 1. Icahn School of Medicine at Mount Sinai, New York, NY;2. Cincinnati Children's Hospital Medical Center, Cincinnati, OH;3. Oregon Health Sciences University, Portland, OR;4. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA;5. Johns Hopkins, Baltimore, MD;6. Cleveland Clinic, Cleveland, OH;7. University of Washington, Seattle, WA;8. Emory University Hospital, Atlanta, GA;9. University of Alberta, Edmonton, Alberta, Canada;10. Northwestern University Feinberg School of Medicine, Chicago, IL;11. University of Miami Miller School of Medicine, Miami, FL;12. Division of Urology, Department of Surgery, I‐Shou University, Kaohsiung City, Taiwan;13. Spectrum Health, Grand Rapids, MI;14. OneLegacy, Los Angeles, CA;15. LifeShare of Oklahoma, Oklahoma City, OK;16. Cornell University, New York, NY;17. Walter Reed National Military Medical Center, Bethesda, MD;18. Seattle Children's Hospital, Seattle, WA;19. The Children's Hospital of Philadelphia, Philadelphia, PA;20. Children's National Medical Center, Washington, DC;21. Pediatrics Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA;22. Washington University, St. Louis, MO;23. University of Alabama at Birmingham, Birmingham, AL;24. University of Insubria, Varese, Italy;25. Henry Ford Hospital, Detroit, MI;26. Massachusetts General Hospital, Boston, MA;27. University of Toronto, Toronto, Ontario |
| Abstract: | Use of organs from donors testing positive for hepatitis B virus (HBV) may safely expand the donor pool. The American Society of Transplantation convened a multidisciplinary expert panel that reviewed the existing literature and developed consensus recommendations for recipient management following the use of organs from HBV positive donors. Transmission risk is highest with liver donors and significantly lower with non‐liver (kidney and thoracic) donors. Antiviral prophylaxis significantly reduces the rate of transmission to liver recipients from isolated HBV core antibody positive (anti‐HBc+) donors. Organs from anti‐HBc+ donors should be considered for all adult transplant candidates after an individualized assessment of the risks and benefits and appropriate patient consent. Indefinite antiviral prophylaxis is recommended in liver recipients with no immunity or vaccine immunity but not in liver recipients with natural immunity. Antiviral prophylaxis may be considered for up to 1 year in susceptible non‐liver recipients but is not recommended in immune non‐liver recipients. Although no longer the treatment of choice in patients with chronic HBV, lamivudine remains the most cost‐effective choice for prophylaxis in this setting. Hepatitis B immunoglobulin is not recommended. |
| Keywords: | clinical research/practice infectious disease infection and infectious agents viral: hepatitis B donors and donation: donor‐derived infections |