Hepatitis B Virus NAT Positive Donors in Non‐Hepatic Organ Transplant: Quantifying Viral Loads to Optimize Recipient Risk Stratification and Management in the Prevention of Donor‐Derived Infection
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Wiley
2025
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| author | Patrick C. K. Tam Goni Katz‐Greenberg Cameron R. Wolfe Kristen Lott Carl L. Berg Adam D. DeVore John M. Reynolds Jennifer L. Saullo |
| author_facet | Patrick C. K. Tam Goni Katz‐Greenberg Cameron R. Wolfe Kristen Lott Carl L. Berg Adam D. DeVore John M. Reynolds Jennifer L. Saullo Patrick C. K. Tam Goni Katz‐Greenberg Cameron R. Wolfe Kristen Lott Carl L. Berg Adam D. DeVore John M. Reynolds Jennifer L. Saullo |
| collection | Wiley Open Access |
| contents | Hepatitis B Virus NAT Positive Donors in Non‐Hepatic Organ Transplant: Quantifying Viral Loads to Optimize Recipient Risk Stratification and Management in the Prevention of Donor‐Derived Infection Patrick C. K. Tam Goni Katz‐Greenberg Cameron R. Wolfe Kristen Lott Carl L. Berg Adam D. DeVore John M. Reynolds Jennifer L. Saullo Clinical Transplantation ABSTRACTTransplantation is one of the few life‐saving therapies for patients with end‐stage organ disease, yet organ availability remains restrictive. Expanding donors to include those with hepatitis B virus (HBV) infection, incorporating HBV nucleic acid amplification testing (NAT) positive donors, could improve organ access. However, the risk of donor‐derived HBV transmission and recipient management of organs transplanted from HBV NAT‐positive donors, particularly in thoracic organ recipients, is limited. We conducted a single‐center retrospective study to assess the safety and outcomes in recipients of non‐hepatic organ transplants from HBV NAT‐positive donors. Over a 4.5‐year period, 25 transplant recipients, including 16 thoracic organ recipients, received organs from 22 unique, qualitative HBV NAT‐positive donors. All recipients were HBV surface antibody‐positive prior to transplant. Quantitative NAT was performed in 20/22 (91%) donors with values ranging from 0 to 1 280 000 IU/mL; 8/22 (36%) donors had HBV NAT values that were undetected or below the lower limit of quantification. All recipients were administered HBV immunoglobulin (HBIG) and received HBV active antiviral therapy post‐transplant. Recipients were followed post‐transplant for a median of 250 days (IQR: 169–467 days). No recipients developed de novo HBV infection characterized by HBV surface antigen (HBsAg) seroconversion, quantifiable HBV NAT detection, or sustained HBV core antibody (HbcAb) seroconversion post‐transplant. Similarly, no recipient developed liver dysfunction or died due to HBV infection. Quantifying HBV from NAT‐positive donors may better inform the risk of donor‐derived infection in recipients, and the use of these organs incorporating a multimodal prevention strategy could safely increase the donor pool. 10.1111/ctr.70236 http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| doi_str_mv | 10.1111/ctr.70236 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_ctr_70236 |
| institution | Wiley Open Access |
| license_str_mv | http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| publishDate | 2025 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Hepatitis B Virus NAT Positive Donors in Non‐Hepatic Organ Transplant: Quantifying Viral Loads to Optimize Recipient Risk Stratification and Management in the Prevention of Donor‐Derived Infection Patrick C. K. Tam Goni Katz‐Greenberg Cameron R. Wolfe Kristen Lott Carl L. Berg Adam D. DeVore John M. Reynolds Jennifer L. Saullo Clinical Transplantation Hepatitis B Virus NAT Positive Donors in Non‐Hepatic Organ Transplant: Quantifying Viral Loads to Optimize Recipient Risk Stratification and Management in the Prevention of Donor‐Derived Infection Patrick C. K. Tam Goni Katz‐Greenberg Cameron R. Wolfe Kristen Lott Carl L. Berg Adam D. DeVore John M. Reynolds Jennifer L. Saullo Clinical Transplantation ABSTRACTTransplantation is one of the few life‐saving therapies for patients with end‐stage organ disease, yet organ availability remains restrictive. Expanding donors to include those with hepatitis B virus (HBV) infection, incorporating HBV nucleic acid amplification testing (NAT) positive donors, could improve organ access. However, the risk of donor‐derived HBV transmission and recipient management of organs transplanted from HBV NAT‐positive donors, particularly in thoracic organ recipients, is limited. We conducted a single‐center retrospective study to assess the safety and outcomes in recipients of non‐hepatic organ transplants from HBV NAT‐positive donors. Over a 4.5‐year period, 25 transplant recipients, including 16 thoracic organ recipients, received organs from 22 unique, qualitative HBV NAT‐positive donors. All recipients were HBV surface antibody‐positive prior to transplant. Quantitative NAT was performed in 20/22 (91%) donors with values ranging from 0 to 1 280 000 IU/mL; 8/22 (36%) donors had HBV NAT values that were undetected or below the lower limit of quantification. All recipients were administered HBV immunoglobulin (HBIG) and received HBV active antiviral therapy post‐transplant. Recipients were followed post‐transplant for a median of 250 days (IQR: 169–467 days). No recipients developed de novo HBV infection characterized by HBV surface antigen (HBsAg) seroconversion, quantifiable HBV NAT detection, or sustained HBV core antibody (HbcAb) seroconversion post‐transplant. Similarly, no recipient developed liver dysfunction or died due to HBV infection. Quantifying HBV from NAT‐positive donors may better inform the risk of donor‐derived infection in recipients, and the use of these organs incorporating a multimodal prevention strategy could safely increase the donor pool. 10.1111/ctr.70236 http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| title | Hepatitis B Virus NAT Positive Donors in Non‐Hepatic Organ Transplant: Quantifying Viral Loads to Optimize Recipient Risk Stratification and Management in the Prevention of Donor‐Derived Infection |
| topic | Clinical Transplantation |
| url | https://onlinelibrary.wiley.com/doi/10.1111/ctr.70236 |