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 (2024)

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.

Title 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

Author Te, Helen S. : University of Chicago : (https://orcid.org/0000-0002-3172-6184)
Lee, Dong Heun : University of California, San Francisco
Woolley, Ann E. : Division of Infectious Diseases
Abidi, Maheen Z. : Division of Infectious Diseases : (https://orcid.org/0000-0002-0783-6535)
Fisher, Cynthia : Division of Allergy & Infectious Diseases
Sellers, Marty T. : Tennessee Donor Services
Taimur, Sarah : Mt. Sinai Medical Center : (https://orcid.org/0000-0002-1776-7510)
Livelli, Taylor : United Network for Organ Sharing
Watkins, Tamika : United Network for Organ Sharing
Handarova, Dzhuliyana : United Network for Organ Sharing
Berry, Gerald J. : Stanford University
Graves, Riki : Houston Methodist Hospital
Ho, Chak-Sum : Gift of Hope Organ & Tissue Donor Network
Hughart, Anna L. : Mayo Clinic
Kittleson, Michelle : Cedars Sinai Medical Center
Marboe, Charles C. : New York Presbyterian Hospital
Miller, Rachel A. : Duke University
Sharma, Tanvi S. : Boston Children's Hospital
Trindade, Anil J. : Vanderbilt University : (https://orcid.org/0000-0003-1399-7228)
Wood, R. Patrick : LifeGift Organ Donation Center
Zaffiri, Lorenzo N. : Cedars-Sinai Medical Center
Pouch, Stephanie M. : Emory University : (https://orcid.org/0000-0002-5628-2444)
Danziger-Isakov, Lara : Cincinnati Children's Hospital Medical Center : (https://orcid.org/0000-0002-5691-5221)

Content Type Article

Published in Transplant Infectious Disease

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

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

Publication Date 2024-06-16

Language English

Copyright Statement

© 2024 The Author(s)

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Record Created 2024-06-17