Outcomes of Entecavir Prophylaxis in Hepatitis B Immune Patients Receiving Hepatitis B Infected Kidneys: A Single Center Experience

• Published in: Current transplantation reports Vol. 11; no. 1; pp. 15 - 19
• Main Authors: Muqueet, Sameera, Reddy, Nikhil A., Curtis, Anna, Madhrira, Machaiah, Allam, Sridhar R., Reyad, Ashraf
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-03-2024
• Subjects: Immunology; Medicine; Medicine & Public Health; Surgery; Topical Collection on Kidney Transplantation; Transplant Surgery; HBV immunization; Kidney transplant; Hepatitis B infected donors; Seroconversion; Entecavir
• ISSN: 2196-3029; 2196-3029
• DOI: 10.1007/s40472-023-00425-1

Purpose of Review
Hepatitis B (HBV) vaccinated patients have mixed responses with regard to antibody titers and subsequent level of immunity. This review aims to examine the diverse strategies employed by transplant centers for infection prevention when utilizing HBV-infected kidneys, including our own center’s practice.
Recent Findings
Transplant centers have implemented varied prophylaxis approaches based on recipients’ anti-HB titers for utilizing HBV-infected kidneys. We retrospectively reviewed ten recipients who received kidneys from HBV-positive donors at our center. Recipients with anti-HBs titers above 100 mIU/mL received entecavir prophylaxis, while those with lower titers received perioperative HBIG. Throughout the follow-up, all patients remained negative for HBV NAT and HBsAg. Six patients experienced asymptomatic anti-HBc seroconversion, of which two patients cleared anti-HBc within 1 year. One patient experienced a decline in anti-HBs titers below 100 mIU/mL but remained free of HBV infection.
Summary
The utilization of Hepatitis B-infected kidneys for transplantation in HBV-immunized recipients is safe. Asymptomatic seroconversion is frequent, but viremia is prevented by immunization and/or entecavir. The role of HBIG prophylaxis is unclear. Most patients with preoperative anti-HBs titer > 100 mIU/mL maintain those titers during the first-year post-transplant.