The impact of donor hepatitis B virus infection on transplant outcomes in deceased donor kidney transplantation recipients.

IF 2.9 3区医学 Q1 UROLOGY & NEPHROLOGY Kidney Research and Clinical Practice Pub Date : 2024-07-24 DOI:10.23876/j.krcp.23.233

You Luo, Rui Zhang, Xiao Hu, Zuofu Tang, Jinhua Zhang, Jiaqing Wu, Ning Na, Hengjun Xiao

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Abstract

Background: The use of hepatitis B virus (HBV)-positive donor kidneys to expand the donor pool has been implemented, but limited evidence exists regarding their impact on transplant outcomes. This study aimed to investigate the effects of donor HBV infection on transplant outcomes.

Methods: Donor and recipient data between 2015 and 2021 were collected. A total of 743 kidney transplant cases were screened, including 94 donor hepatitis B surface antigen (HBsAg)+/recipient HBsAg- (D+R-) and 649 donor HBsAg-/recipient HBsAg- (D-R-) cases. The analysis endpoints included recipient HBV infection, delayed graft function (DGF), peak estimated glomerular filtration rate (eGFR) within 12 months, recipient survival, and death-censored graft survival (DCGS).

Results: The D+R- group had a significantly higher risk of HBV infection compared to the D-R- group (6/72 vs. 3/231; relative risk, 6.4; p = 0.007). The risk of HBV transmission decreased significantly with increasing hepatitis B surface antibody (HBsAb) titer (p for trend = 0.003). Furthermore, the D+R- group did not exhibit an increased risk of DGF compared to the D-R- group (odds ratio, 0.70; p = 0.51) in the multivariable mixed model. Both groups had similar peak eGFR within 12 months (β = 1.01, p = 0.71), and this had no impact on patient survival (hazard ratio [HR], 0.36; p = 0.10) and DCGS (HR, 0.79, p = 0.59) in the shared-frailty Cox model.

Conclusion: The use of HBsAg-positive donor kidneys appears relatively safe for HBV-immunized recipients in the short term. D+R- does not negatively affect graft function recovery and provides comparable posttransplant outcomes. Maintaining an HBsAb titer over 100 IU/L before transplantation is critical to reduce the risk of HBV transmission.

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供体乙型肝炎病毒感染对已故供体肾移植受者移植结果的影响。

背景：使用乙型肝炎病毒（HBV）阳性供体肾脏以扩大供体库的做法已经开始实施，但有关其对移植结果影响的证据有限。本研究旨在调查供体 HBV 感染对移植结果的影响：收集了 2015 年至 2021 年间的供体和受体数据。共筛查了 743 例肾移植病例，包括 94 例供体乙型肝炎表面抗原（HBsAg）+/受体 HBsAg-（D+R-）和 649 例供体 HBsAg-/受体 HBsAg-（D-R-）病例。分析终点包括受体 HBV 感染、延迟移植物功能（DGF）、12 个月内估计肾小球滤过率（eGFR）峰值、受体存活率和死亡剪除移植物存活率（DCGS）：结果：与 D-R- 组相比，D+R- 组的 HBV 感染风险明显更高（6/72 对 3/231；相对风险 6.4；P = 0.007）。随着乙型肝炎表面抗体（HBsAb）滴度的增加，HBV 传播的风险明显降低（趋势 p = 0.003）。此外，在多变量混合模型中，与 D-R- 组相比，D+R- 组发生 DGF 的风险并没有增加（几率比 0.70；P = 0.51）。两组患者在 12 个月内的 eGFR 峰值相似（β = 1.01，p = 0.71），这对患者的生存期（危险比 [HR]，0.36；p = 0.10）和 DCGS（HR，0.79，p = 0.59）没有影响：结论：使用 HBsAg 阳性的供肾在短期内对 HBV 免疫受者似乎相对安全。D+R-不会对移植物功能的恢复产生负面影响，并能提供相似的移植后效果。移植前保持 HBsAb 滴度超过 100 IU/L 对于降低 HBV 传播风险至关重要。

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来源期刊

Kidney Research and Clinical Practice UROLOGY & NEPHROLOGY-

CiteScore

4.60

自引率

10.00%

发文量

审稿时长

10 weeks

期刊介绍： Kidney Research and Clinical Practice (formerly The Korean Journal of Nephrology; ISSN 1975-9460, launched in 1982), the official journal of the Korean Society of Nephrology, is an international, peer-reviewed journal published in English. Its ISO abbreviation is Kidney Res Clin Pract. To provide an efficient venue for dissemination of knowledge and discussion of topics related to basic renal science and clinical practice, the journal offers open access (free submission and free access) and considers articles on all aspects of clinical nephrology and hypertension as well as related molecular genetics, anatomy, pathology, physiology, pharmacology, and immunology. In particular, the journal focuses on translational renal research that helps bridging laboratory discovery with the diagnosis and treatment of human kidney disease. Topics covered include basic science with possible clinical applicability and papers on the pathophysiological basis of disease processes of the kidney. Original researches from areas of intervention nephrology or dialysis access are also welcomed. Major article types considered for publication include original research and reviews on current topics of interest. Accepted manuscripts are granted free online open-access immediately after publication, which permits its users to read, download, copy, distribute, print, search, or link to the full texts of its articles to facilitate access to a broad readership. Circulation number of print copies is 1,600.