Prognostic implications of recipient or donor hepatitis B seropositivity in thoracic transplantation: analysis of 426 hepatitis B surface antigen-positive recipients

• Published in: Transplant infectious disease 2014-08, Vol.16 (4), p.597-604
• Main Authors: Manickam, P., Krishnamoorthi, R., Kanaan, Z., Gunasekaran, P.K., Cappell, M.S.
• Format: Article
• Language: English
• Subjects: Adult; all-cause mortality; Female; HBcAb; HBsAg; Heart Transplantation; Heart-Lung Transplantation; Hepatitis B - complications; Hepatitis B Antibodies - blood; hepatitis B core antibody; Hepatitis B Core Antigens - immunology; hepatitis B surface antigen; Hepatitis B Surface Antigens - isolation & purification; Hepatitis B virus; Humans; Lung Transplantation; Male; Middle Aged; Proportional Hazards Models; Risk Factors; survival analysis; thoracic transplants
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.12256

Background Prognostic data on survival of hepatitis B surface antigen‐positive (HBsAg+) recipients and of hepatitis B core antibody‐positive (HBcAb+) donors are limited in the thoracic transplantation (TT) cohort. Improved understanding of risks could potentially expand the recipient and donor pools. Methods Post‐hoc analysis of limited‐access dataset of the United Network for Organ Sharing database from January 2000–September 2010 was performed. Analyses were performed for all TT, including single and bilateral lung, orthotopic heart, and simultaneous heart‐lung transplants. The primary analyzed outcome was overall survival. A Cox proportional multivariate hazards model was used to adjust for significant risk predictors. Results Of 24,817 patients included, 426 recipients were HBsAg+, of whom 106 (25%) died during a mean follow‐up of 3.6 years. On multivariate analysis, recipient HBsAg+ (hazard ratio [HR] = 0.88, 95% confidence interval [CI]: 0.69–1.32; P = 0.80), and donor HBcAb+ (HR = 0.91, 95% CI: 0.68–1.22; P = 0.53) were not associated with increased overall mortality in the entire TT cohort, with similar results for each individual transplant cohort. Unadjusted survival analysis using Kaplan–Meier curves in individual transplant cohorts did not show significant differences between HBsAg+ and HBsAg− recipients. No statistically significant differences were found between causes of mortality in the 2 groups. Conclusion HBsAg+ status of recipients or HBcAb+ status of donors does not significantly affect overall survival of TT recipients. These data add to the scant literature on this subject and could potentially increase the donor and recipient pools.