Author information

¹Center for Liver Diseases, Chicago, Illinois, USA.

²Division of Infectious Diseases, University of California San Francisco Medical Center, San Francisco, California, USA.

³Division of Infectious Diseases, Boston, Massachusetts, USA.

⁴Division of Infectious Diseases, Denver, Colorado, USA.

⁵Division of Allergy & Infectious Diseases, Seattle, Washington, USA.

⁶Tennessee Donor Services, Nashville, Tennessee, USA.

⁷Division of Infectious Diseases, Mt. Sinai Medical Center, New York, New York, USA.

⁸United Network for Organ Sharing, Richmond, Virginia, USA.

⁹Department of Pathology, Stanford University Medical Center, Stanford, California, USA.

¹⁰Sherrie and Alan Conover Center for Liver Disease & Transplantation, Houston Methodist Hospital, Houston, Texas, USA.

¹¹Gift of Hope Organ & Tissue Donor Network, Itasca, Illinois, USA.

¹²William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Minnesota, Minnesota, USA.

¹³Cardiology Department, Cedars Sinai Medical Center, Los Angeles, California, USA.

¹⁴Department of Pathology and Cell Biology, New York Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA.

¹⁵Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, USA.

¹⁶Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA.

¹⁷Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

¹⁸LifeGift Organ Donation Center, Houston, Texas, USA.

¹⁹Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.

²⁰Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.

²¹Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.

Abstract

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.