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

Abstract

Transplantation 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.