Kidney transplantation from anti-HBc+ donors: results from a retrospective Italian study

Background. The risk of transmitting a hepatitis B virus (HBV) infection from donor kidneys with a past HBV serological profile may be negligible. Data on HBV transmission to kidney transplant recipients from donor organs that were anti-HBc(+)/HBsAg(-) in Italy has not been previously reported. Anti-HBc testing in cadaver organ donors has been mandatory in Italy since 2002, when anti-HBc determinations were included in the National Guidelines for donor evaluation. Therefore, prior to that date kidney recipients from anti-HBc(+)/HBsAg(-) donors can be identified retrospectively where stored serum is available for testing. Methods. The prevalence of anti-HBc(+) Italian organ donors, the incidence of HBV transmission according to the recipients' HBV status (vaccinated, recovered, or naive), and the clinical impact (5-year graft and patient survival rates) in the North Italy Transplant program was evaluated by retrospectively screening for anti-HBc antibodies in the sera of cadaver kidney donors used in transplants from 1997 to 1999. Results. Two hundred and ten donors were found to have been anti-HBc+. At the time of the study, no active infection was observed in any of the 344 HBsAg(-) recipients, but 4/140 (2.86%) of the vaccinated recipients were found to have been anti-HBc+/HBsAg-. None of these patients, however, had any biochemical or clinical history of HBV infection. Patient and graft survival rates of anti-HBc(+) or anti-HBc(-) kidney recipients did not differ statistically. Conclusion. Kidney grafts from anti-HBc(+) donors should be considered in all recipients because the benefit obtained from the transplantation out weighs the negligible risk of HBV transmission.