Transmission of viral hepatitis by kidney transplantation: donor evaluation and transplant policies (Part 1: hepatitis B virus)

Natov, S; Pereira, Brian J.G.

doi:10.1034/j.1399-3062.2002.t01-1-01002.x

Cited by 61 publications

(44 citation statements)

References 26 publications

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“…These findings suggest a direct adverse effect of DHCVϩ kidneys on survival in renal transplant recipients, rather than greater severity of preexisting illness in patients who are given DHCVϩ kidneys. Recent recommendations include restricting the use of DHCVϩ kidneys to patients who are HCV RNA positive, not just ELISA positive (9). However, it is not clear that such patients would be protected from infection by all strains of HCV.…”

Section: Discussionmentioning

confidence: 99%

Hepatitis C and Renal Transplantation in the Era of Modern Immunosuppression

Abbott¹,

Bucci²,

Matsumoto³

et al. 2003

Journal of the American Society of Nephrology

102

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Abstract. Kidneys from donors who are positive for hepatitis C virus (DHCVϩ) have recently been identified as an independent risk factor for mortality after renal transplantation. However, it has not been determined whether risk persists after adjustment for baseline cardiac comorbidity or applies in the era of modern immunosuppression. Therefore, a historical cohort study was conducted of US adult cadaveric renal transplant recipients from January 1, 1996, to May 31, 2001 followed until October 31, 2001. A total of 36,956 patients had valid donor and recipient HCV serology. Cox regression analysis was used to model adjusted hazard ratios for mortality and graft loss, respectively, adjusted for other factors, including comorbid conditions from Center for Medicare and Medicaid Studies Form 2728 and previous dialysis access-related complications. It was found that DHCVϩ was independently associated with an increased risk of mortality (adjusted hazard ratio, 2.12, 95% confidence interval, 1.72 to 2.87; P Ͻ 0.001), primarily as a result of infection. Mycophenolate mofetil was associated with improved survival in DHCVϩ patients, primarily related to fewer infectious deaths. Adjusted analyses limited to recipients who were HCVϩ, HCV negative, or age 65 and over, or by use of mycophenolate mofetil confirmed that DHCVϩ was independently associated with mortality in each subgroup. It is concluded that DHCVϩ is independently associated with an increased risk of mortality after renal transplantation adjusted for baseline comorbid conditions in all subgroups. Recipients of DHCVϩ organs should be considered at high risk for excessive immunosuppression.The expected clinical course of hepatitis C infection as it affects organ transplant recipients, as well as the use and effect of kidneys from donors who are positive for hepatitis C, remain controversial topics in renal transplantation. Recently published data confirmed that kidneys from donors who were hepatitis C positive (HCVϩ) were associated with an independently increased risk of death in renal transplant recipients regardless of recipient HCV status (1). However, donor hepatitis C seropositivity (DHCVϩ) was not independently associated with mortality when limited to patients with valid information (Centers for Medicare and Medicaid Studies [CMS] Form 2728) on comorbid conditions at the time of dialysis initiation. This may have been because of the relatively small numbers of transplant recipients for whom complete data were available during the study period or because cardiovascular comorbidity was actually lower in patients who received DHCVϩ kidneys, yet the mortality risk for recipients of DHCVϩ kidneys was still greater than for patients who received DHCVϪ kidneys. Possibly, recipients of DHCVϩ kidneys were sicker to start with and thus had a higher risk of death unrelated to receiving a DHCVϩ kidney. Since that study, there have been substantial changes in maintenance immunosuppression practices in the United States. In particular, recent reports have confirmed tha...

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Section: Discussionmentioning

confidence: 99%

Hepatitis C and Renal Transplantation in the Era of Modern Immunosuppression

Abbott¹,

Bucci²,

Matsumoto³

et al. 2003

Journal of the American Society of Nephrology

102

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“…Recent organ shortages have led to active use of kidneys from HBV-positive donors, especially in geographic areas in which HBV infection is endemic. 12,13 We also performed KT only when donor DNA tests for HBV were negative and the recipient was immune to HBV. The recipients remained HBsAg-negative 11 months after KT.…”

Section: Discussionmentioning

confidence: 99%

A Single-Center Experience of Overseas Kidney Transplant for Immunologically High-Risk Patients

Jung

Park

Jun³

et al. 2015

Exp Clin Transplant

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Objectives: We report our experience in treating Mongolian patients transferred to our center in Korea to undergo kidney transplants, including immunologically high-risk patients. Materials and Methods: Between September 2009 and February 2013, thirty-three Mongolian patients underwent kidney transplants at our center with the approval of the Korean Network for Organ Sharing. Their clinical data were retrospectively collected and analyzed. Results: The mean age of the transplant recipients was 38.8 ± 10.5 years, and the causes of end-stage renal disease were glomerulonephritis (5), diabetes mellitus (2), hypertension (3), and unknown (25). These cases included ABO incompatibility, high levels of sensitization, and retransplant, at frequencies of 9, 12, and 9. Basiliximab (30) or antithymocyte globulin (2) was administered as the induction therapy, and combination regimens of plasmapheresis with or without intravenous immunoglobulins and/or rituximab were used in some high-risk patients. The mean follow-up after kidney transplant was 12.87 ± 11.7 months. During the follow-up, antibody-mediated rejection and graft failure occurred in 2 patients. In addition, cytomegalovirus infection, calcineurin inhibitor toxicity, and BK viremia developed in 1 patient each. The mean estimated glomerular filtration rates at 1, 6, and 12 months after kidney transplant were 88.2 ± 26.9 mL/min/1.73 m 2 , 67.5 ± 14.9 mL/min/ 1.73 m 2 , and 63.9 ± 21.1 mL/min/1.73 m 2 . In addition, subgroup analysis revealed that ABOincompatible and immunologically high-risk recipients had comparable renal function status during the follow-up Conclusions: We found that an overseas kidney transplant program in Korea could be conducted safely, even in high-risk patients. Therefore, a proper cooperation and transfer system for these high-risk patients between neighboring countries might help in providing improved medical care in this setting.

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“…4 Renal transplant from HBsAg positive donors to HBsAg negative recipients successfully using natural immunity began to emerge in endemic areas from 1988. 6 Living-donor kidney transplant from HBsAgpositive donors to hepatitis B antibody-positive recipients were reported in only 45 cases in Hong Kong, Saudi Arabia, Turkey, and the United States.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the shortage of renal grafts and the good outcome of hepatitis B virus (HBV) infection with medication, kidney transplant with HBV-infected deceased donors has been accepted generally. [1][2][3][4] However, kidney transplant from HBV-infected living donors has been avoided due to the possibility of graft instability and HBV transmission, except in some studies. 5 In this study, living-donor kidney transplant from chronically HBV-infected donors was considered as a possibility to compensate for insufficiency of organ transplants, particularly in an HBV-endemic country where many potential donors are already infected.…”

Section: Introductionmentioning

confidence: 99%

Living-Donor Kidney Transplant From Hepatitis B Surface Antigen-Positive Donors to Hepatitis B Antibody-Positive Recipients Without Hepatitis B Immunoglobulin Prophylaxis in an Endemic Country

Jun

Kim

Park

et al. 2015

Exp Clin Transplant

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Objectives: Living-donor kidney transplant from donors who are chronically infected with hepatitis B virus can be considered as a possibility to compensate for insufficiency of organ transplants, particularly in a hepatitis B virus endemic country. In this study, the safety and efficacy were reviewed retrospectively in living-donor kidney transplant from donors who were chronically infected with hepatitis B virus.

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Transmission of viral hepatitis by kidney transplantation: donor evaluation and transplant policies (Part 1: hepatitis B virus)

Cited by 61 publications

References 26 publications

Hepatitis C and Renal Transplantation in the Era of Modern Immunosuppression

Hepatitis C and Renal Transplantation in the Era of Modern Immunosuppression

A Single-Center Experience of Overseas Kidney Transplant for Immunologically High-Risk Patients

Living-Donor Kidney Transplant From Hepatitis B Surface Antigen-Positive Donors to Hepatitis B Antibody-Positive Recipients Without Hepatitis B Immunoglobulin Prophylaxis in an Endemic Country

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