Kidney Allograft From Asymptomatic HBV Donor
Kidney Allograft From Asymptomatic HBV Donor
A kidney allograft from an asymptomatic hepatitis B virus (HBV) surface antigen (HBsAg)-positive donor was transplanted into a recipient who was HBsAb-positive. The recipient was vaccinated for HBV. What is the expected course? Should we give immunoglobulin for HBV or lamivudine to the recipient before transplantation? Is there a risk for acute HBV infection in the recipient?
Hilmi Dikici, MD
This is a very good question. It is important to know the status of viral replication in the donor. If the donor is actively replicating HBV DNA, then one should consider using HBIg at least during the surgery and for a few days postoperatively to block the viral particles that may be transplanted with the organ, and then you should use lamivudine to suppress the virus. The optimal duration of therapy is not known; however, if the recipient is persistently HBsAb-positive, one could discontinue treatment after several months to a year. If the donor is not actively replicating the virus, then lamivudine alone and monitoring serologies should be sufficient.
A kidney allograft from an asymptomatic hepatitis B virus (HBV) surface antigen (HBsAg)-positive donor was transplanted into a recipient who was HBsAb-positive. The recipient was vaccinated for HBV. What is the expected course? Should we give immunoglobulin for HBV or lamivudine to the recipient before transplantation? Is there a risk for acute HBV infection in the recipient?
Hilmi Dikici, MD
This is a very good question. It is important to know the status of viral replication in the donor. If the donor is actively replicating HBV DNA, then one should consider using HBIg at least during the surgery and for a few days postoperatively to block the viral particles that may be transplanted with the organ, and then you should use lamivudine to suppress the virus. The optimal duration of therapy is not known; however, if the recipient is persistently HBsAb-positive, one could discontinue treatment after several months to a year. If the donor is not actively replicating the virus, then lamivudine alone and monitoring serologies should be sufficient.
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