Biological Sciences Division
Published June 16, 2024 | Version v1
Journal article Open

Hepatitis B transmission/reactivation associated with Hepatitis B core antibody and Hepatitis C nucleic acid testing positive organs: A report from the Organ Procurement and Transplantation Network Disease Transmission Advisory Committee

Creators

  • 1. University of Chicago
  • 2. University of California, San Francisco
  • 3. Division of Infectious Diseases
  • 4. Division of Allergy & Infectious Diseases
  • 5. Tennessee Donor Services
  • 6. Mt. Sinai Medical Center
  • 7. United Network for Organ Sharing
  • 8. Stanford University
  • 9. Houston Methodist Hospital
  • 10. Gift of Hope Organ & Tissue Donor Network
  • 11. Mayo Clinic
  • 12. Cedars Sinai Medical Center
  • 13. New York Presbyterian Hospital
  • 14. Duke University
  • 15. Boston Children's Hospital
  • 16. Vanderbilt University
  • 17. LifeGift Organ Donation Center
  • 18. Cedars-Sinai Medical Center
  • 19. Emory University
  • 20. Cincinnati Children's Hospital Medical Center

Description

Background: Better access to direct-acting antiviral (DAA) therapy has broadened the utilization of hepatitis C virus (HCV) nucleic acid testing (NAT) positive organs with excellent outcomes. However, DAA therapy has been associated with hepatitis B virus (HBV) reactivation.

Aim: To determine the risk of HBV transmission or reactivation with utilization of HBV core antibody positive (HBcAb+) and HCV NAT positive (HCV+) organs, which presumably required DAA therapy.

Methods: The number of HBcAb+ donors with delineated HCV NAT status was obtained from the Organ Procurement and Transplantation Network (OPTN) database. The number of unexpected HBV infections from transplanted organs adjudicated as "proven" or "probable" transmission was obtained from the OPTN Ad Hoc Disease Transmission Advisory Committee database. A chart review of the donors of "proven" or "probable" cases was conducted.

Results: From January 1, 2016, to December 31, 2021, 7735 organs were procured from 3767 HBcAb+ donors and transplanted into 7469 recipients; 545 (14.5%) donors were also HCV+. HBV transmission or reactivation occurred in seven recipients. The rate is not significantly different between recipients of HCV+ (0.18%, 2/1115) and the HCV NAT negative (HCV-) organs (0.08%, 5/6354) (p = 0.28) or between recipients of HCV+ and HCV- livers as well as non-liver organs. HBV transmission or reactivation occurred within a median of 319 (range, 41-1117) days post-transplant in the setting of missing, inadequate, or truncated prophylaxis.

Conclusion: HBV reactivation associated with DAA therapy for HBcAb+ HCV+ organs is less frequent than reported in the non-transplant population, possibly due to the common use of HBV prophylaxis in the at-risk transplant population.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Additional details

Identifiers

DOI
10.1111/tid.14305
Other
oai:uchicago.tind.io:12663

Funding

U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Health Systems Bureau, Division of Transplantation
HHSH250201900001C

UChicago Information

Division(s)
Biological Sciences Division
Department(s)
Medicine